Johnston Melanie A, Goss Rachel, Chandra Kavish, Goss Robert, Atkinson Paul
Emergency Medicine, Queen Elizabeth Hospital, Charlottetown, CAN.
Emergency Medicine, Saint John Regional Hospital, Dalhousie University, Saint John, CAN.
Cureus. 2024 Sep 19;16(9):e69713. doi: 10.7759/cureus.69713. eCollection 2024 Sep.
Demand for emergency services has resulted in an increased number of physicians experiencing burnout. Burnout rates amongst emergency medicine physicians consistently exceed that of other specialties, with shift work being a large contributor to the phenomenon. Casino-shift scheduling has addressed this issue in several emergency departments (EDs). Casino-shift scheduling is modeled around circadian rhythm theory which shows that anchor sleep helps to preserve circadian rhythm and normalize sleep patterns. To account for this, casino-shift models schedule overnight coverage with two six-hour shifts, to allow both physicians to obtain some sleep within the 01:00 to 06:00 am anchor period. While the benefits of the model have been demonstrated concerning physician well-being, there is a paucity of evidence assessing if this model has any effect on quality measures such as patient flow. Given the importance of patient flows to ED functioning, the objective of our study was to determine the effect of a casino-shift trial on overnight patient flow variables in a tertiary ED.
We performed a retrospective analysis of administrative data for overnight (10:00 pm to 10:00 am) patient flow variables during a two-month casino-shift intervention period (September 9, 2019, to November 4, 2019) compared with a control period at an ED in Eastern Canada. We analyzed various measures of patient flow for patients presenting overnight between 10:00 pm to 10:00 am during the study period. Primary outcome measures were wait time (WT), length of stay (LOS), and admission rates.
Of the 19170 patient visits, 16787 met inclusion criteria. The median overnight WTs for the casino-shift intervention period were longer at 68 minutes (interquartile range (IQR) 31-154 minutes), compared with 51 minutes (IQR 21-104 minutes) in the control group. The LOS for the intervention was 217 minutes (IQR 132-358 minutes) compared with 195 minutes (IQR 112-336 minutes) for the control. There were 166 admissions/month during the trial, and 193 admissions/month during the 10-month control period.
In our study, our patient flow indicators of median WT and LOS were longer in the casino-shift intervention period by an absolute difference of 17 minutes and 22 minutes respectively. As a relatively new concept in emergency medicine scheduling, the impact of the casino-shift model on both well-being and ED efficiency warrants further investigation given the potential benefits to an occupation prone to burnout.
对急诊服务的需求导致越来越多的医生出现职业倦怠。急诊医学医生的职业倦怠率一直高于其他专科，轮班工作是导致这一现象的一个重要因素。赌场式轮班排班已在多个急诊科解决了这一问题。赌场式轮班排班是围绕昼夜节律理论建立的，该理论表明固定睡眠时间有助于维持昼夜节律并使睡眠模式正常化。考虑到这一点，赌场式轮班模式安排通宵值班为两个六小时班次，以便两名医生都能在凌晨1点至6点的固定睡眠时间内获得一些睡眠。虽然该模式对医生幸福感的益处已得到证明，但缺乏证据评估该模式是否对诸如患者流量等质量指标有任何影响。鉴于患者流量对急诊科运作的重要性，我们研究的目的是确定赌场式轮班试验对一家三级急诊科通宵患者流量变量的影响。
我们对加拿大东部一家急诊科在为期两个月的赌场式轮班干预期（2019年9月9日至2019年11月4日）期间通宵（晚上10点至上午10点）患者流量变量的管理数据进行了回顾性分析，并与一个对照期进行比较。我们分析了研究期间晚上10点至上午10点就诊患者的各种患者流量指标。主要结局指标为等待时间（WT）、住院时间（LOS）和入院率。
在19170次患者就诊中，16787次符合纳入标准。赌场式轮班干预期的通宵WT中位数较长，为68分钟（四分位间距（IQR）31 - 154分钟），而对照组为51分钟（IQR 21 - 104分钟）。干预组的LOS为217分钟（IQR 132 - 358分钟），而对照组为195分钟（IQR 112 - 336分钟）。试验期间每月有166例入院，10个月对照期每月有193例入院。
在我们的研究中，赌场式轮班干预期我们的患者流量指标WT中位数和LOS分别延长了17分钟和22分钟。作为急诊医学排班中的一个相对较新的概念，鉴于对易出现职业倦怠的职业有潜在益处，赌场式轮班模式对幸福感和急诊科效率的影响值得进一步研究。
