McKee M, Priest P, Ginzler M, Black N
Health Services Research Unit, London School of Hygiene and Tropical Medicine.
Ann R Coll Surg Engl. 1991 Sep;73(5):295-301; discussion 301-2.
During the 1980s there has been increasing concern about hospital medical staffing. Achieving a Balance will lead to a reduction in the number of registrars and a possible increase in the work done out-of-hours by consultants. The deleterious effects of long hours of work have also attracted attention and, in particular, there is concern about the safety of operations performed at night by unsupervised junior doctors. There is an urgent need to examine how out-of-hours work can be reduced. This study was conducted in two phases. The out-of-hours surgical workload in four hospitals was examined. Appropriateness of the procedures and activities being carried out was then considered by a consensus panel, aided by a literature review. Most out-of-hours operations were performed by junior staff. The principal reasons suggested for operating at night are lack of day-time theatre space and the need to gain experience. There was considerable variation in the frequency with which different types of operation were performed among hospitals. The views of the panel suggest that up to one-third of operations currently performed at night could be postponed. It may be possible to postpone a higher proportion of operations performed after midnight. The appropriateness of the remaining operations has major implications for the work of consultants following the implementation of Achieving a Balance.
在20世纪80年代，人们对医院医疗人员配备的关注日益增加。实现平衡将导致住院医生数量减少，顾问医生在非工作时间完成的工作量可能会增加。长时间工作的有害影响也引起了关注，特别是有人担心夜间由无人监督的初级医生进行手术的安全性。迫切需要研究如何减少非工作时间的工作。本研究分两个阶段进行。对四家医院的非工作时间手术工作量进行了检查。然后由一个共识小组在文献综述的帮助下，考虑所进行的程序和活动的适当性。大多数非工作时间的手术由初级工作人员进行。建议在夜间进行手术的主要原因是白天手术室空间不足以及需要积累经验。不同类型手术在各医院的执行频率存在很大差异。该小组的意见表明，目前在夜间进行的手术中，高达三分之一可以推迟。午夜后进行的手术可能可以推迟更高的比例。其余手术的适当性对实施“实现平衡”后顾问医生的工作有重大影响。
