Jeanmonod Rebecca, Damewood Sara, Brook Christopher
Department of Emergency Medicine, St. Luke's Hospital, Bethlehem, PA 18015, USA.
Int J Emerg Med. 2009 May 30;2(2):107-10. doi: 10.1007/s12245-009-0109-8.
It has been shown that residents' ability to see more patients and patients of higher acuity improves with level of training.
No published study has reviewed whether residents become less productive with consecutive shifts. Determining peak resident productivity can optimize staffing to manage patient flow and enhance resident exposure to patients, which is critical to their education. We examine the relationship between resident productivity and number of consecutive shifts worked.
This is a retrospective review of emergency medicine (EM) resident productivity defined as patients evaluated per hour per shift. Data were collected utilizing patient tracker software which provides a record of physician assignment and checked against the computerized medical record. Residents were credited with a patient if they initiated the workup and dictated the chart. Productivity was tallied for 188 first-year shift strings, 303 second-year shift strings, and 224 third-year shift strings beginning 1 November 2006. Analysis of variance (ANOVA) was used to assess for productivity differences based on the shift number, with the first shift in a series being designated "1," the second consecutive shift being designated "2," and so on.
First-year residents saw 0.82, 0.81, and 0.91 patients per hour on consecutive shifts (F((2,175))=2.89, p = 0.06), second-year residents saw 1.12, 1.08, 1.17, and 1.28 patients per hour on consecutive shifts (F((3,292))=4.19, p = 0.006), and third-year residents saw 1.19, 1.24, and 1.33 patients per hour on consecutive shifts (F((2,211))=4.08, p = 0.02).
Instead of tiring, residents maintain or improve productivity over consecutive shifts.
研究表明，随着培训水平的提高，住院医师诊治更多患者及诊治更高 acuity 患者的能力也会提升。
尚无已发表的研究探讨住院医师连续值班时工作效率是否会降低。确定住院医师的最高工作效率有助于优化人员配置以管理患者流量，并增加住院医师接触患者的机会，这对他们的教育至关重要。我们研究了住院医师工作效率与连续值班次数之间的关系。
这是一项对急诊医学（EM）住院医师工作效率的回顾性研究，工作效率定义为每班每小时评估的患者数量。利用患者跟踪软件收集数据，该软件提供医生分配记录，并与电子病历进行核对。如果住院医师开始检查并记录病历，则记为诊治了一名患者。统计了从2006年11月1日开始的188个一年级值班序列、303个二年级值班序列和224个三年级值班序列的工作效率。采用方差分析（ANOVA）评估基于值班次数的工作效率差异，系列中的第一个值班记为“1”，第二个连续值班记为“2”，依此类推。
一年级住院医师连续值班时每小时诊治患者数分别为0.82、0.81和0.91（F((2,175))=2.89，p = 0.06），二年级住院医师连续值班时每小时诊治患者数分别为1.12、1.08、1.17和1.28（F((3,292))=4.19，p = 0.006），三年级住院医师连续值班时每小时诊治患者数分别为1.19、1.24和1.33（F((2,211))=4.08，p = 0.02）。
住院医师在连续值班期间工作效率保持不变或有所提高，而非降低。
