Department of Paediatrics, Research Institute, Toronto, Ontario, Canada.
Pediatrics. 2011 Jun;127(6):1080-7. doi: 10.1542/peds.2010-1955. Epub 2011 May 23.
On July 1, 2009, in Ontario the maximum period of continuous duty that residents were permitted to work was reduced from 28 to 24 hours. We evaluated the effect of regulation on residents in 3 eras: 2 before (2005 and early 2009) and 1 after (late 2009) the duty-hour reduction.
On-call pediatric residents on pediatric medicine rotations prospectively recorded the numbers of patients (assigned and admitted) and the durations of direct patient care, documentation, staff supervision, and education attended. Sleep was measured with actigraphy.
The 51 residents worked 180 duty periods, were assigned a median of 6 (interquartile range: 4 -12) daytime patients and 24 (interquartile range: 19-30) overnight patients. Residents reported spending means of 239 minutes providing direct patient care, 235 minutes documenting, and 243 minutes sleeping and receiving 73 minutes of staff supervision and 52 minutes of education. From early 2009 to after duty-hour reduction, residents provided 47 fewer (19.6%) minutes of direct patient care (P = .056) and received 44 fewer minutes (60.3%) of supervision (P = .0005) but spent similar times documenting, receiving education, and sleeping. In early 2009, residents provided 73 more minutes (30.5%) of direct patient care (P = .0016), spent 63 more minutes (26.8%) documenting, and slept 105 fewer minutes (43.0%) (P = .0062) than in 2005.
After duty-hour reduction in 2009, we found reduced supervision and direct patient care. Comparison of the 2 periods before duty-hour reduction showed less sleep and longer patient contact in early 2009, which suggests that changes occurred without regulation.
2009 年 7 月 1 日，安大略省将住院医师允许连续工作的最长时间从 28 小时减少到 24 小时。我们评估了 3 个时期（减少前的 2005 年和 2009 年初以及减少后的 2009 年末）的监管对住院医师的影响。
儿科轮转的住院医师使用活动记录仪前瞻性地记录患者数量（分配和收治）和直接患者护理、文件记录、员工监督和参加教育的持续时间。
51 名住院医师共完成 180 个值班周期，白天平均分配 6 名（四分位间距：4-12 名），夜间分配 24 名（四分位间距：19-30 名）。住院医师报告的直接患者护理时间平均为 239 分钟，记录时间为 235 分钟，睡眠时间为 243 分钟，接受员工监督时间为 73 分钟，接受教育时间为 52 分钟。从 2009 年初到减少值班时间后，住院医师提供的直接患者护理时间减少了 47 分钟（19.6%）（P=0.056），接受的监督时间减少了 44 分钟（60.3%）（P=0.0005），但记录、接受教育和睡眠的时间相似。2009 年初，住院医师提供的直接患者护理时间增加了 73 分钟（30.5%）（P=0.0016），记录时间增加了 63 分钟（26.8%），睡眠时间减少了 105 分钟（43.0%）（P=0.0062）。
2009 年减少值班时间后，我们发现监督和直接患者护理减少了。减少值班时间前的 2 个时期的比较显示，2009 年初睡眠减少，与患者接触时间延长，这表明没有监管规定的情况下也发生了变化。
