Department of Industrial and Operations Engineering, University of Michigan, 1205 Beal Ave., Ann Arbor, MI, 48109, USA,
Health Care Manag Sci. 2014 Mar;17(1):1-14. doi: 10.1007/s10729-013-9237-z. Epub 2013 Apr 28.
The new Accreditation Council for Graduate Medical Education (ACGME) duty-hour standards for residents and fellows went into effect in 2011. These regulations were designed to reduce fatigue-related medical errors and improve patient safety. The new shift restrictions, however, have led to more frequent transitions in patient care (handoffs), resulting in greater opportunity for communication breakdowns between caregivers, which correlate with medical errors and adverse events. Recent research has focused on improving the quality of these transitions through standardization of the handoff protocols; however, no attention has been given to reducing the number of transitions in patient care. This research leverages integer programming methods to design a work shift schedule for trainees that minimizes patient handoffs while complying with all ACGME duty-hour standards, providing required coverage, and maintaining physician quality of life. In a case study of redesigning the trainees' schedule for a Mayo Clinic Medical Intensive Care Unit (MICU), we show that the number of patient handoffs can be reduced by 23 % and still meet all required and most desired scheduling constraints. Furthermore, a 48 % reduction in handoffs could be achieved if only the minimum required rules are satisfied.
新的住院医师规范化培训认证委员会（ACGME）住院医师和研究员的工作时间标准于 2011 年生效。这些规定旨在减少与疲劳相关的医疗错误，提高患者安全性。然而，新的轮班限制导致患者护理（交接班）更频繁地转换，从而增加了护理人员之间沟通中断的机会，这与医疗错误和不良事件相关。最近的研究集中在通过交接协议的标准化来提高这些交接的质量；然而，对于减少患者护理中的交接次数，却没有引起足够的重视。本研究利用整数规划方法为学员设计一个工作班次表，在遵守所有 ACGME 工作时间标准、提供所需的覆盖范围并维持医生生活质量的同时，最大限度地减少患者交接班次数。在对梅奥诊所重症监护病房（MICU）学员时间表进行重新设计的案例研究中，我们表明可以减少 23%的患者交接班次数，同时仍然满足所有要求和大多数期望的调度约束。如果只满足最低要求的规则，则可以减少 48%的交接班次数。
