Jeanmonod Rebecca, Jeanmonod Donald, Ngiam Ryan
Department of Emergency Medicine, Albany Medical College, Mail Code 139, Albany, NY 12208, USA.
Am J Emerg Med. 2008 Sep;26(7):789-91. doi: 10.1016/j.ajem.2007.10.037.
It has been established that residents are able to evaluate more patients per hour as they progress through training. However, it is unknown if shift length influences resident productivity.
The aim of this study is to assess whether there is a difference in second-year resident productivity as a function of shift length.
This is a retrospective chart review of patients evaluated in the emergency department (ED) by second-year residents in a 65,000 volume center; 9- and 12-hour shifts were included. Nine-hour shifts provide a 1-hour overlap, such that three 9-hour shifts provide 24 hours of resident coverage. Shifts on weekly conference day were excluded. A patient was determined as having been evaluated by a resident if the resident initiated care on the patient and dictated the chart. Data were analyzed using 2-tailed t test.
A total of 193 nine-hour shifts and 90 twelve-hour shifts met inclusion criteria. Residents working 12-hour shifts evaluated 1.06 patients per hour, and residents working 9-hour shifts evaluated 1.15 patients per hour (95% confidence interval, 0.031-0.151). In an ED with 120 hours of resident coverage per day, this results in 10 additional patients seen by residents working 9-hour shifts. In our department with 9 ED months in the second year of residency, this results in 180 additional patient encounters per resident during that year.
Shorter shift lengths appear to result in more patients evaluated per hour by second-year residents and an increase in patient encounters.
已有研究证实，住院医师在培训过程中每小时能够评估更多患者。然而，轮班时长是否会影响住院医师的工作效率尚不清楚。
本研究旨在评估二年级住院医师的工作效率是否因轮班时长而异。
这是一项对一家年接诊量达65000人次的中心急诊科二年级住院医师所评估患者的回顾性病历审查；纳入了9小时和12小时轮班。9小时轮班有1小时的重叠时间，即三个9小时轮班可提供24小时的住院医师覆盖时间。每周会议日的轮班被排除。如果住院医师开始对患者进行治疗并书写病历，则该患者被确定为由该住院医师评估。数据采用双侧t检验进行分析。
共有193个9小时轮班和90个12小时轮班符合纳入标准。上12小时轮班的住院医师每小时评估1.06名患者，上9小时轮班的住院医师每小时评估1.15名患者（95%置信区间为0.031 - 0.151）。在一个每天有120小时住院医师覆盖时间的急诊科，这意味着上9小时轮班的住院医师多看10名患者。在我们科室，住院医师二年级的9个急诊月中，这导致每位住院医师每年多看180名患者。
较短的轮班时长似乎会使二年级住院医师每小时评估的患者更多，患者接诊量增加。
