Fisher E W, Moffat D A, Quinn S J, Wareing M J, Von Blumenthal H, Morris D P
Department of Otolaryngology, Addenbrooke's Hospital, Cambridge.
Ann R Coll Surg Engl. 1994 Sep;76(5 Suppl):232-5.
This study aimed to assess the effects of recent controls on juniors' duty hours (the 'New Deal') on the work performed by all grades of ENT medical staff 'out of hours'. For 100 days in 1993 the out of hours duties of all grades of doctor in the Otolaryngology Unit were monitored using daily logs. Three patterns of cover were run in parallel and subjected to comparison: Light: Senior House Officer (SHO)--Consultant (CON); Traditional: SHO-Intermediate (Registrar or Senior Registrar)--Consultant; Cross-cover--Pre-Registration House Officer (PRHO)--Intermediate-Consultant. The SHO 'out of hours' daily workload did not differ significantly between the traditional and light systems (median hours: 5.6 versus 5.0). There was an increase in working hours for the intermediate (registrar or senior registrar) grade of 84 per cent when the cross-cover system was in operation compared with the traditional system (median hours: 5.0 versus 2.8; p < 0.0001--Mann-Whitney U test). Consultant working hours increased by an average of 132 per cent as a result of removal of the intermediate tier (median hours: 1.7 versus 0.80; p < 0.0001). Reduction in on-call hours of junior staff resulted in a need for cross-cover and also in the frequent removal of an intermediate tier of staff. This has been shown to have a considerable effect on working patterns for intermediate and senior grades in an ENT unit of average size. Further reductions would be expected to have major effects on the working patterns of the consultant grade and considerably dilute the emergency experience of trainees.
本研究旨在评估近期对初级医生值班时长的管控措施（“新政”）对耳鼻喉科各级医护人员非工作时间工作的影响。1993年，通过每日日志对耳鼻喉科所有级别医生的非工作时间值班情况进行了为期100天的监测。同时并行实施了三种值班模式并进行比较：轻量模式：高级住院医师（SHO）——顾问医生（CON）；传统模式：SHO——中级医生（住院医师或高级住院医师）——顾问医生；交叉覆盖模式——预注册住院医师（PRHO）——中级医生——顾问医生。传统模式和轻量模式下SHO的每日非工作时间工作量无显著差异（中位数时长：5.6小时对5.0小时）。与传统模式相比，交叉覆盖模式运行时中级（住院医师或高级住院医师）级别的工作时长增加了84%（中位数时长：5.0小时对2.8小时；p<0.0001——曼-惠特尼U检验）。由于取消了中级层级，顾问医生的工作时长平均增加了132%（中位数时长：1.7小时对0.80小时；p<0.0001）。初级员工值班时长的减少导致需要交叉覆盖，也导致中级层级员工经常被取消。这已被证明对中等规模耳鼻喉科单位中级和高级层级的工作模式有相当大的影响。预计进一步减少将对顾问医生层级的工作模式产生重大影响，并大幅削弱实习生的急诊经验。
