Blakey John D, Fearn Andrew, Shaw Dominick E
Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK ; Department of Respiratory Medicine, Aintree University Hospital, Liverpool, L9 7AL, UK.
JRSM Short Rep. 2013 Jul 5;4(8):2042533313489823. doi: 10.1177/2042533313489823. eCollection 2013.
To investigate whether measurements of junior doctor on-call workload and performance can clarify the mechanisms underlying the increase in morbidity and mortality seen after junior doctor changeover: the 'August effect'.
Quantitative retrospective observational study of routinely collected data on junior doctor workload.
Two large teaching hospitals in England.
Task level data from a wireless out of hours system (n = 29,885 requests) used by medical staff, nurses, and allied health professionals.
Number and type of tasks requested by nurses, time to completion of tasks by junior doctors.
There was no overall change in the number of tasks requested by nurses out of hours around the August changeover (median requests per hour 15 before and 14 after, p = 0.46). However, the number of tasks classified as urgent was greater (p = 0.016) equating to five more urgent tasks per day. After changeover, doctors took less time to complete tasks overall due to a reduction in time taken for routine tasks (median 74 vs. 66 min; p = 3.9 × 10(-9)).
This study suggests that the 'August effect' is not due to new junior doctors completing tasks more slowly or having a greater workload. Further studies are required to investigate the causes of the increased number of urgent tasks seen, but likely factors are errors, omissions, and poor prioritization. Thus, improved training and quality control has the potential to address this increased duration of unresolved patient risk. The study also highlights the potential of newer technologies to facilitate quantitative study of clinical activity.
调查初级医生值班工作量和工作表现的测量是否能阐明初级医生交接班后发病率和死亡率增加背后的机制：“八月效应”。
对常规收集的初级医生工作量数据进行定量回顾性观察研究。
英国的两家大型教学医院。
医务人员、护士和专职医疗人员使用的无线非工作时间系统的任务级别数据（n = 29885条请求）。
护士请求的任务数量和类型，初级医生完成任务的时间。
八月交接班前后非工作时间护士请求的任务数量没有总体变化（每小时请求中位数：之前为15，之后为14，p = 0.46）。然而，分类为紧急任务的数量更多（p = 0.016），相当于每天多五项紧急任务。交接班后，由于常规任务所需时间减少，医生完成任务的总体时间减少（中位数74分钟对66分钟；p = 3.9×10⁻⁹）。
本研究表明“八月效应”并非由于新的初级医生完成任务更慢或工作量更大。需要进一步研究以调查紧急任务数量增加的原因，但可能的因素是错误、遗漏和优先级排序不当。因此，改进培训和质量控制有可能解决未解决的患者风险持续时间增加的问题。该研究还强调了新技术在促进临床活动定量研究方面的潜力。
