Christmas A Britton, Reynolds Jennifer, Hodges Samantha, Franklin Glen A, Miller Frank B, Richardson J David, Rodriguez Jorge L
Department of Surgery, University of Louisville, Louisville, Kentucky 40292, USA.
J Trauma. 2005 May;58(5):917-20. doi: 10.1097/01.ta.0000162736.06947.e3.
The implementation of revised surgical resident work hours has led many teaching hospitals to integrate health care extenders into the trauma service. We undertook this review to assess the effectiveness of these individuals in meeting the goals of the work hour restrictions and whether they impact other hospital and patient outcomes.
During the year 2002, we integrated two nurse practitioners into the trauma service of a teaching hospital. We prospectively collected data a year before (2001), during (2002), and a year after (2003) the integration that included number of admissions, hospital length of stay, intensive care stay, floor length of stay, mortality, direct cost per case, and weekly resident work hours on 44 residents at all levels.
After the incorporation of physician extenders, we observed statistically significant reductions in floor, intensive care unit, and overall hospital lengths of stay. Patient mortality and cost per patient remained unchanged. Furthermore, we were able to obtain compliance with the Accreditation Council for Graduate Medical Education requirements for residency work hour limitations, as the average number of hours worked per resident on the trauma service decreased from 86 hours to 79 hours per week.
As graduate medical education becomes ever more regulated, physician extenders can be successfully integrated into busy academic Level I trauma centers. This integration positively impacts patient flow and resident work hours without altering patient outcomes or direct hospital cost.
修订后的外科住院医师工作时长规定实施后，许多教学医院将医疗辅助人员纳入创伤服务团队。我们进行此项综述，以评估这些人员在实现工作时长限制目标方面的有效性，以及他们是否会影响医院的其他指标和患者的治疗结果。
2002年，我们将两名执业护士纳入一家教学医院的创伤服务团队。我们前瞻性地收集了整合前一年（2001年）、整合期间（2002年）和整合后一年（2003年）的数据，包括各级44名住院医师的入院人数、住院时间、重症监护时间、普通病房住院时间、死亡率、每例直接成本以及每周工作时长。
纳入医师辅助人员后，我们观察到普通病房、重症监护病房和总体住院时间在统计学上有显著缩短。患者死亡率和每位患者的成本保持不变。此外，我们能够符合毕业后医学教育认证委员会对住院医师工作时长限制的要求，因为创伤服务团队中每位住院医师的平均每周工作时长从86小时降至79小时。
随着毕业后医学教育受到越来越多的规范，医师辅助人员可以成功融入繁忙的学术型一级创伤中心。这种整合对患者流程和住院医师工作时长有积极影响，同时不会改变患者治疗结果或医院直接成本。
