Lurie N, Rank B, Parenti C, Woolley T, Snoke W
Department of Medicine, Hennepin County Medical Center, Minneapolis, MN 55415.
N Engl J Med. 1989 Jun 22;320(25):1673-7. doi: 10.1056/NEJM198906223202507.
Recommendations to limit the working hours of house staff are forcing directors of training programs to reevaluate how house officers spend their time. We studied how 35 house officers in internal medicine spent their on-call time in three teaching hospitals: an urban county hospital, a university hospital, and a regional Veterans Administration medical center. Trained observers accompanied each member of different on-call teams for five nights and quantified how their time was spent. Teams consisting of residents and interns admitted three new patients per night at the Veterans Administration hospital, six at the university hospital, and eight at the county hospital. Each house officer received 16 to 25 calls per night. Up to 12 percent of their time was spent doing procedures (such as inserting intravenous catheters or drawing blood specimens) most of which could have been done by nonphysicians. From 87 to 175 minutes of on-call time was spent in direct patient evaluation, and the mean time spent on each new-patient evaluation ranged from 17 to 31 minutes. The mean time before the evaluation was interrupted ranged from 7 to 11 minutes. In contrast, 66 to 197 minutes per night was spent documenting new-patient evaluations in the hospital record. The average sleep time ranged from 122 to 273 minutes; however, the mean time before sleep was interrupted ranged from 40 to 86 minutes. We conclude that while on call, house officers spend relatively little time in direct patient contact, but they spend considerable time charting. They are frequently interrupted while working and trying to sleep. These data may be useful in finding administrative ways to improve patient care and the experience of the house staff while on call and in evaluating the effect of reforms.
限制住院医师工作时长的建议促使培训项目主任重新评估住院医师的时间分配情况。我们研究了35名内科住院医师在三家教学医院的值班时间安排：一家城市县医院、一家大学医院和一家地区退伍军人管理局医疗中心。经过培训的观察员连续五个晚上跟随不同值班团队的每位成员，量化他们的时间分配情况。退伍军人管理局医院由住院医师和实习医师组成的团队每晚收治三名新患者，大学医院为六名，县医院为八名。每位住院医师每晚接到16至25个电话。他们高达12%的时间用于执行操作（如插入静脉导管或采集血样），其中大部分操作非医生也可完成。用于直接评估患者的值班时间为87至175分钟，每位新患者评估的平均用时为17至31分钟。评估被打断前的平均时长为7至11分钟。相比之下，每晚用于在医院记录中记录新患者评估情况的时间为66至197分钟。平均睡眠时间为122至273分钟；然而，入睡被打断前的平均时长为40至86分钟。我们得出结论，值班期间，住院医师直接接触患者的时间相对较少，但用于记录的时间较多。他们在工作和试图入睡时经常被打断。这些数据可能有助于找到行政方法，以改善患者护理以及住院医师值班时的体验，并评估改革的效果。
