Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas.
Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas.
J Surg Educ. 2021 Jul-Aug;78(4):1280-1285. doi: 10.1016/j.jsurg.2020.12.008. Epub 2020 Dec 29.
In this quality improvement project, we analyzed surgeon focus and attention utilizing a visual tracking device. We hypothesized that surgeons maintained better focus working 12-hour shifts compared to 24-hour calls.
A prospective, quality improvement project was performed on surgery residents, medical students, and attending physicians working at a busy, tertiary referral, safety-net hospital with Level 1 trauma and burn centers. A visual tracking system was used to measure visual attention before and after a 12-hour, in-house shift and a 24-hour, surgical in-house call. A pupil tracker was utilized to measure attention impairment. Individual performance was rated on a scale of 0 to 6: Severely Impaired- 0; Impaired- 1; Low Average- 2; Average- 3; Above Average- 4; High Average- 5; Superior- 6. Data were analyzed for homogeneity. The Wilcoxon Ranked Sum was used to assess for statistically significant differences between focus scores in the same group of individuals before and after shifts and/or calls. The Mann-Whitney U test was used to compare differences in focus between 12 and 24 hour in-house shifts and/or calls.
A total of 21 surgeons provided a total of 61 visual tracking tests for analysis. Results were found to be nonhomogeneous. The project population was 46% men with a median age of 31 years IQR (28-33). General surgery residents accounted for 48 tests, medical students for 2, and attending surgeons for 11. Average hours of self-reported sleep before the shift/call was 6 (IQR; 6-7). There was almost no overall change in focus in individuals before and after a 12-hour, in-house shift -0.06 (SD 1.9), while after a 24- hour, in-house call, focus decreased by almost 2 full grades -1.8 (SD 1.6) (p = 0.013). There was no statistically significant difference in focus found between 12-hour day shift and 12-hour night shift.
Twelve-hour shifts appear to preserve focus in surgeons better compared with 24- hour, in-house calls. More research is needed to establish the optimal time of surgeon focus maintenance and shift duration.
在这项质量改进项目中，我们利用视觉跟踪设备分析了外科医生的注意力。我们假设与 24 小时值班相比，外科医生在 12 小时轮班时能够保持更好的注意力。
对在一家繁忙的三级转诊、有医保的医院工作的外科住院医师、医学生和主治医生进行了一项前瞻性、质量改进项目。该医院设有 1 级创伤和烧伤中心。使用视觉跟踪系统在 12 小时院内轮班和 24 小时院内值班前后测量视觉注意力。使用瞳孔跟踪器测量注意力障碍。个体表现评分为 0 至 6 分：严重受损-0 分；受损-1 分；低平均-2 分；平均-3 分；高于平均-4 分；高平均-5 分；优秀-6 分。对数据进行同质性分析。Wilcoxon 秩和检验用于评估同一组个体在轮班前后的注意力得分是否存在统计学显著差异。Mann-Whitney U 检验用于比较 12 小时和 24 小时院内轮班/值班的注意力差异。
共有 21 名外科医生共提供了 61 次视觉跟踪测试进行分析。结果显示非同质。项目人群中 46%为男性，中位年龄为 31 岁（IQR：28-33）。普通外科住院医师占 48 项，医学生占 2 项，主治医生占 11 项。轮班前/值班前自我报告的平均睡眠时间为 6 小时（IQR：6-7）。与 12 小时院内轮班相比，个体的注意力几乎没有变化-0.06（标准差 1.9），而在 24 小时院内值班后，注意力几乎下降了 2 个等级-1.8（标准差 1.6）（p=0.013）。在 12 小时白班和 12 小时夜班之间，没有发现注意力存在统计学显著差异。
与 24 小时值班相比，12 小时轮班似乎能更好地保持外科医生的注意力。需要进一步研究以确定维持外科医生注意力的最佳时间和轮班时间。
