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      Modelling the impacts of COVID-19 on nurse workload and quality of care using process simulation

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          Abstract

          Higher acuity levels in COVID-19 patients and increased infection prevention and control routines have increased the work demands on nurses. To understand and quantify these changes, discrete event simulation (DES) was used to quantify the effects of varying the number of COVID-19 patient assignments on nurse workload and quality of care. Model testing was based on the usual nurse-patient ratio of 1:5 while varying the number of COVID-19 positive patients from 0 to 5. The model was validated by comparing outcomes to a step counter field study test with eight nurses. The DES model showed that nurse workload increased, and the quality of care deteriorated as nurses were assigned more COVID-19 positive patients. With five COVID-19 positive patients, the most demanding condition, the simulant-nurse donned and doffed personal protective equipment (PPE) 106 times a shift, totaling 6.1 hours. Direct care time was reduced to 3.4 hours (-64% change from baseline pre-pandemic case). In addition, nurses walked 10.5km (+46% increase from base pre-pandemic conditions) per shift while 75 care tasks (+242%), on average, were in the task queue. This contributed to 143 missed care tasks (+353% increase from base pre-pandemic conditions), equivalent to 9.6 hours (+311%) of missed care time and care task waiting time increased to 1.2 hours (+70%), in comparison to baseline (pre-pandemic) conditions. This process simulation approach may be used as potential decision support tools in the design and management of hospitals in-patient care settings, including pandemic planning scenarios.

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          Most cited references71

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          A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research.

          Intraclass correlation coefficient (ICC) is a widely used reliability index in test-retest, intrarater, and interrater reliability analyses. This article introduces the basic concept of ICC in the content of reliability analysis.
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              The intraclass correlation coefficient as a measure of reliability.

              J J Bartko (1966)
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SoftwareRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: ValidationRole: VisualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                13 October 2022
                2022
                13 October 2022
                : 17
                : 10
                : e0275890
                Affiliations
                [1 ] Human Factors Engineering Lab, Toronto Metropolitan University (Formerly, Ryerson University), Toronto, Canada
                [2 ] Daphne Cockwell School of Nursing, Toronto Metropolitan University (Formerly, Ryerson University), Toronto, Canada
                [3 ] University Health Network, Toronto, Canada
                Jonkoping University, SWEDEN
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                ‡ MAG and HK also contributed equally to this work.

                Author information
                https://orcid.org/0000-0003-4309-6674
                https://orcid.org/0000-0002-5294-0729
                https://orcid.org/0000-0001-6354-8581
                https://orcid.org/0000-0002-1560-3870
                Article
                PONE-D-21-30724
                10.1371/journal.pone.0275890
                9560613
                36228015
                5a37fef6-04f7-4af8-bdcb-ef9ba8a6079f
                © 2022 Qureshi et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 23 September 2021
                : 26 September 2022
                Page count
                Figures: 9, Tables: 3, Pages: 21
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100000024, Canadian Institutes of Health Research;
                Award Recipient :
                This research was funded by Canadian Institutes of Health Research’s (CIHR) Canadian 2019 Novel Coronavirus (COVID-19) Rapid Research Funding Grant. https://cihr-irsc.gc.ca/e/51908.html The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                People and Places
                Population Groupings
                Professions
                Medical Personnel
                Nurses
                Medicine and Health Sciences
                Health Care
                Health Care Providers
                Nurses
                Medicine and Health Sciences
                Medical Conditions
                Infectious Diseases
                Viral Diseases
                Covid 19
                Medicine and Health Sciences
                Epidemiology
                Pandemics
                Medicine and Health Sciences
                Health Care
                Quality of Care
                Medicine and Health Sciences
                Health Care
                Health Care Providers
                Allied Health Care Professionals
                Medicine and Health Sciences
                Diagnostic Medicine
                Virus Testing
                Engineering and Technology
                Equipment
                Safety Equipment
                Medicine and Health Sciences
                Public and Occupational Health
                Safety
                Safety Equipment
                Research and Analysis Methods
                Simulation and Modeling
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.
                COVID-19

                Uncategorized
                Uncategorized

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