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Workload In Neonatology (WORKLINE): Validation and feasibility of a system for measuring clinician workload integrated into the electronic health record



The purpose of the study was to validate WORKLINE, a NICU specific clinician workload model and to evaluate the feasibility of integrating WORKLINE into our EHR.

Study design

This was a prospective, observational study of the workload of 42 APPs and physicians in a large academic medical center NICU over a 6-month period. We used regression models with robust clustered standard errors to test associations of WORKLINE values with NASA Task Load Index (NASA-TLX) scores.


We found significant correlations between WORKLINE and NASA-TLX scores. APP caseload was not significantly associated with WORKLINE scores. We successfully integrated the WORKLINE model into our EHR to automatically generate workload scores.


WORKLINE provides an objective method to quantify the workload of clinicians in the NICU, and for APPs, performed better than caseload numbers to reflect workload. Integrating the WORKLINE model into the EHR was feasible and enabled automated workload scores.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.


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The authors would like to thank the Vanderbilt University Medical Center Office of Evidence-Based Practice and Nursing Research for their support of the project and the Departments of Pediatrics and Bioinformatics for Dr. Alrifai’s grant funding to support the project. This work was supported by the Evelyn Selby Stead Fund for Innovation, Vanderbilt University Medical Center, and the Department of Pediatrics Turner-Hazinski Research Award, Vanderbilt University Medical Center (MWA). Use of the Research Electronic Data Capture program (REDCap) was supported by UL1 TR000445 from NCATS/NIH.


Dr. Hatch serves on the Scientific Advisory Board of Novonate Inc. and receives stock options as part of that appointment.

Author information

Authors and Affiliations



MED was responsible for creating the workload model (WORKLINE), writing the research protocol, recruiting study participants, interpreting results, and writing the manuscript. PR, LDH, and DF provided guidance on protocol development, analysis of results, and manuscript edits. TAS was responsible for development of the electronic surveys and set-up of the text messaging application used during the study and blinded results of the participants to insure confidentiality during the study. MSD conducted the statistical analysis for the study and assisted with manuscript edits. MWA was responsible for integrating the WORKLINE model into the EHR, revising the research protocol, recruiting study participants, interpreting results, obtaining grant funding, and revising the manuscript.

Corresponding author

Correspondence to M. Eva Dye.

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The authors declare no competing interests.

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Dye, M.E., Runyan, P., Scott, T.A. et al. Workload In Neonatology (WORKLINE): Validation and feasibility of a system for measuring clinician workload integrated into the electronic health record. J Perinatol 43, 936–942 (2023).

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