[Measurements of productivity and efficiency of a first level director in a cardiology referral clinic. Their use in the final determination of work load in accordance with DL 29/1993].
OBJECTIVE
The law demands that the work-load (WL) in the Public Health Service be defined, and also dictates audit criteria referring to: a) the total activities performed during the previous three years; b) the standard times (STD) required to perform the different activities; c) the degree of demand fulfillment (DDF). Aim of this study is to establish the WL of 19 cardiologists (C) operating in a referral Hospital.


METHODS
We examined the years 1993-1995. We calculated all medical procedures (P) carried out by our Institute ("procedure" method), and we determined the theoretical time needed to perform them based on STD. The activities of the Coronary Unit (CCU) and of the Ward (W) have been evaluated based on the duty-time table ("presence" method). The sum of the hours calculated with the two methods is the theoretical duty-time per week (TDT = sigma P x STD Time + CCU hours + W hours). We then measured the actual duty-time (ADT). By comparing TDT and ADT we obtained an efficiency index EI = [(TDT - ADT)/TDT]%. The DDF has been estimated based on the waiting-lists.


RESULTS
We noticed an increase in invasive P and related activities, and a stable trend or a small decrease in non-invasive P, except for echography. TDT was always found to be superior to ADT (1993: 731.3 vs 670; 1994: 742.7 vs 670.9; 1995: 734 vs 652.1) with an increasing IE (8.3; 9.6; 11.1 respectively). We found rather high figures for extra hours per week (mean 31.6), C time (mean 34.9) and hours lost for vacation, illness, etc. (mean 137.5/week, equal to duty-time of more than three C). When GCS was considered, the total WL was 770 hours per week, equal to a duty-time of 19.25 C.


CONCLUSIONS
WL evaluation allows a better understanding of operating conditions ina ward, it is essential when C are committed to pursue specific objectives, and it represents a basis to monitor efficiency. The reliability of WL largely depends upon STD; this underscores the fundamental role of Scientific Societies to prevent a tool intended for a better utilisation of human resources from becoming a pure instrument of cost-containment.
Bernardi
G
G
Istituto di Cardiologia, Ospedale S. Maria della Misericordia (di Rilievo Nazionale e di Alte Specializzazione), Udine.
Tuniz
D
D
Morocutti
G
G
Fontanelli
A
A
D002309:Cardiology / Q000331:legislation & jurisprudence* / Q000592:standards; D003325:Coronary Care Units; D004452:Echocardiography; D006331:Heart Diseases / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007558:Italy; D012017:Referral and Consultation; D014940:Work Schedule Tolerance
Misure di produttività e di efficienza per i medici dirigenti di I livello in una struttura cardiologica di riferimento. Loro utilizzo ai fini della determinazione dei carichi di lavoro secondo il DL 29/1993.