Key takeaways

• A Workload Index (WLI) assessed inpatient oncology advanced practice provider (APP) burden, with a median completion time of 86 seconds. 
• Assignments of 8 rather than 6 patients were associated with a 36% higher mean WLI and more days rated “Too Challenging.” 
• Goals-of-care discussions showed a significant, dose-dependent association with perceived difficulty, supporting their consideration in patient assignments. 

An inpatient hematology/oncology service at the Hospital of the University of Pennsylvania adapted and implemented a Workload Index to assess APP burden beyond patient census, according to an abstract presented at the 2026 JADPRO Live meeting in Minneapolis, Minnesota. The initiative aimed to inform patient assignments and explore associations with workforce retention. 

Following interrater reliability testing, the tool launched as an online survey in September 2025. Providers rated patient acuity on a 1-to-4 Likert scale and recorded precepting status, goals-of-care discussions, admissions, and procedures. Before seeing their WLI score, they rated their day as “Good,” “Somewhat Challenging,” or “Too Challenging.” Over 8 months, 42 providers submitted 1334 assessments. 

Patient acuity and patient count correlated positively with WLI (r = 0.80 and 0.51, respectively; both P < .001), and scores differed significantly across perceived-difficulty categories (P < .001). With 8 versus 6 patients per provider, “Good” days declined from 65% to 28%, while “Too Challenging” days increased from 1% to 15%. Team acuity also predicted days rated “Too Challenging,” and goals-of-care discussions were the only measured event significantly associated with perceived difficulty (P < .001). 

The authors reported lower provider attrition, from a 3-year baseline of 14.51% to 10.06%, alongside reduced mean patient-to-provider ratios, from 7.43 to 6.51. These changes occurred concurrently with improved perceived workload; causality could not be established.  

For oncology APPs, the findings support assignment decisions incorporating acuity and goals-of-care responsibilities rather than census alone. The authors recommended real-time acuity visualization to support equitable assignments and decisions regarding unplanned absences. Further work should evaluate relationships with hospital length of stay and readmissions, while a separate assessment examines workload dimensions not captured by the WLI.  

Source

Kucharczuk CR, Hollander LB, Lightheart E, Allen K, Decena MA, Howard AA. Measuring what matters: implementation of a workload index tool to quantify advanced practitioner burden in an inpatient hematology/oncology advanced practice provider service. Poster presented at: 2026 JADPRO Live; 2026; Minneapolis, MN. Poster JL1434C.