Franks Adam, Petrany Stephen M, McElroy Sydnee, Alley Adam
Department of Family and Community Health, Marshall University.
Fam Med. 2017 Jun;49(6):468-472.
Work hour restriction has strained the balance between resident service and education. Night Float (NF) rotations are a popular answer to managing this balance but weakens continuity, an essential tenant of family medicine. An innovative short call system for Marshall University's Family Medicine Hospital Service (FMHS), the twINTERN call model, was created in response. We studied the impact of this approach on resident fatigue.
Anonymous surveys assessed fatigue of the Marshall University's 2013-2014 Family Medicine intern resident class while on NF rotations (ICU, Pediatrics and Surgery) and the twINTERN call. Stanford Sleepiness Score (SSS) and Epworth Sleepiness Score (ESS) were administered trimonthly. RESULTS were categorized 'Alert' or 'Fatigued' and evaluated by Chi Square analysis. Also, outpatient office frequency was evaluated.
146 surveys were completed by eight residents. More even distribution of resident office experience was seen. The twINTERN call model didn't show worsening fatigue compared to NF systems in any parameter measured. It was superior mitigating fatigue by ESS for night shifts (P value 0.047). While fatigue was statistically worse for night float rotations by both parameters (ESS P value = 0.009; SSS P value = 0.008), the twINTERN call model only showed worsening fatigue in the SSS (P value = 0.038).
Our study demonstrated that the twINTERN Call Model, which allows for improved continuity on the inpatient service, was at least as effective, and by some parameters superior to NF systems for mitigating resident fatigue.
工作时间限制打破了住院医师服务与教育之间的平衡。夜间轮值（NF）是解决这一平衡问题的常用方法，但削弱了连续性，而连续性是家庭医学的一个重要原则。作为回应，马歇尔大学家庭医学医院服务部（FMHS）创建了一种创新的短呼叫系统——双胞胎住院医师呼叫模式（twINTERN call model）。我们研究了这种方法对住院医师疲劳的影响。
通过匿名调查评估了马歇尔大学2013 - 2014年家庭医学实习住院医师在NF轮值（重症监护病房、儿科和外科）以及双胞胎住院医师呼叫期间的疲劳情况。每三个月进行一次斯坦福嗜睡量表（SSS）和爱泼华嗜睡量表（ESS）测评。结果分为“警觉”或“疲劳”两类，并通过卡方分析进行评估。此外，还评估了门诊出诊频率。
8名住院医师完成了146份调查问卷。住院医师门诊经历的分布更加均匀。在任何测量参数中，与NF系统相比，双胞胎住院医师呼叫模式均未显示出疲劳加剧。在夜班时，该模式通过ESS减轻疲劳方面更具优势（P值 = 0.047）。虽然两个参数都显示NF轮值时的疲劳在统计学上更严重（ESS P值 = 0.009；SSS P值 = 0.008），但双胞胎住院医师呼叫模式仅在SSS中显示出疲劳加剧（P值 = 0.038）。
我们的研究表明，双胞胎住院医师呼叫模式在住院服务中能够改善连续性，至少同样有效，并且在某些参数上，在减轻住院医师疲劳方面优于NF系统。
