Jones Gareth J, Vanderpump Mark P J, Easton Mark, Baker Daryll M, Ball Carol, Leenane Michael, O'Brien Heather, Turner Nigel, Else Martin, Reid Wendy M N, Johnson Margaret
Royal Free Hampstead NHS Trust, London.
Clin Med (Lond). 2004 Sep-Oct;4(5):427-30. doi: 10.7861/clinmedicine.4-5-427.
This paper describes the strategy which achieved European Working Time Directive (EWTD) compliance at the Royal Free Hampstead NHS Trust in medicine and surgery. Compliance with EWTD regulations was assessed by diary card exercise, clinical care assessed through critical incident reports, electronic handover documents and nursing reports, training opportunities assessed by unit training directors, cost controls assessed by finance department analysis, and workload assessed by staff attendance on wards, in casualty and in theatres. There was a change in focus of care to a consultant-led, specialist registrar- (SpR-)driven service extending into evenings and on weekends, coupled with a move to a multi-skilled team for night cover, and to a move from traditional on-call shifts to a full shift system across both medicine and surgery. Compliance with the EWTD was achieved whilst maintaining good standards of clinical care, ensuring training opportunities for doctors in training, controlling payroll costs, removing the need for locums, and reducing workload for both junior doctors and consultants.
本文介绍了皇家自由汉普斯特德国民保健服务信托基金在医学和外科领域实现符合《欧洲工作时间指令》（EWTD）的策略。通过工作日志卡活动评估对EWTD法规的遵守情况，通过关键事件报告、电子交接班文件和护理报告评估临床护理，由科室培训主任评估培训机会，由财务部门分析评估成本控制，通过病房、急诊室和手术室的员工出勤情况评估工作量。护理重点发生了变化，转向由顾问主导、专科住院医师（SpR）推动的服务，服务时间延长至晚上和周末，同时转向由多技能团队提供夜间覆盖，并从传统的随叫随到轮班制转变为医学和外科的全轮班制。在保持良好临床护理标准的同时实现了对EWTD的遵守，确保了培训医生的培训机会，控制了薪资成本，不再需要临时医生，并减轻了初级医生和顾问的工作量。
