Lanigan Alexander, Lospinoso Joshua, Bowe Sarah N, Laury Adrienne M
1 Department of Otolaryngology-Head and Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas, USA.
2 Portia Statistical Consulting LLC, San Antonio, Texas, USA.
Otolaryngol Head Neck Surg. 2017 Jun;156(6):1041-1043. doi: 10.1177/0194599816688179. Epub 2017 Jan 24.
Since the initiation of resident duty hour restrictions, significant controversy has arisen regarding its impact on surgical resident training. We reviewed a singular facet of the otolaryngology residency experience, nasal bone fracture management, to identify if treatment standardization would improve care and efficiency. For 1 year, otolaryngology consults for isolated nasal fractures were analyzed to assess consultation trends, rate of intervention, and resident work hour utilization. Following a review of the literature, an evidence-based algorithm for management of nasal fractures was developed. Analysis revealed a potential improvement in intervention rate from 20% to 100% with utilization of the algorithm, with an 84% decrease in overall emergency room and inpatient consultations. Sixty-three hours of otherwise lost resident time would be gained. In the setting of Accreditation for Graduate Medical Education duty hour restrictions, implementation of protocol-driven management may result in a decrease in work hours and serve as a model for more efficient otolaryngology care.
自从开始限制住院医师工作时长以来，关于其对外科住院医师培训的影响出现了重大争议。我们回顾了耳鼻喉科住院医师培训经历中的一个独特方面，即鼻骨骨折的处理，以确定治疗标准化是否会改善护理和提高效率。在一年的时间里，我们分析了耳鼻喉科针对单纯鼻骨骨折的会诊情况，以评估会诊趋势、干预率和住院医师工作时长的利用情况。在回顾文献之后，我们制定了一个基于证据的鼻骨骨折处理算法。分析显示，采用该算法后，干预率有可能从20%提高到100%，急诊室和住院会诊的总数减少了84%。还将节省原本会被浪费的63个小时的住院医师时间。在研究生医学教育认证委员会限制工作时长的背景下，实施协议驱动的管理可能会减少工作时长，并为更高效的耳鼻喉科护理提供一个范例。
