[Clocking diagnostic and therapeutic procedures in coronary care unit patients: analysis of clinical performance times].

BACKGROUND: An optimal use and exploitation of professional personnel is of paramount importance for health management organizations, as human resources are both their greatest asset and heaviest financial burden. To better understand the amount of medic and paramedic work and time required for the typical diagnostic and therapeutic procedures in a coronary-care unit setting, we measured their average times and analyzed their inherent co-factors. METHODS: This study was conducted on 206 consecutive coronary-care unit patients. These patients were divided into subgroups according to their admission diagnosis: acute myocardial infarction, unstable angina, acute cardiac failure, pulmonary embolism or other pathologies. Each subgroup was then subdivided even further according to the severity of their clinical status. Diagnostic and therapeutic procedures ("macroactivities") have been identified and each one was subdivided into sub-procedures ("microactivities"). All microactivities were carefully clocked in every patient in order to calculate the average execution time for every macroactivity. RESULTS: Our data show that myocardial infarction patients and, in general, a more severe clinical status required a longer stay in the coronary-care unit. Again, longer overall clinical performance times were necessary in myocardial infarction patients as compared to the unstable angina subgroup. There were no statistically significant differences among other subgroups. More severely ill patients required longer clinical performance times because of both a longer coronary-care unit stay and longer clinical performance time per day. More than half of the total clinical performance time for each patient was spent during the first two days. Paramedics supplied more than 80% of the total performance time. CONCLUSIONS: The authors undertook a study of typical coronary-care unit clinical activities by clocking the performance times of the usual diagnostic and therapeutic procedures. The data thus obtained come from direct measurements and describe the clinical performance of both medics and paramedics in a real-life setting. This could thus be used as a yardstick to verify current workload standards. It is hoped that a deeper understanding of these activities will optimize the full exploitation of available human resources.