Abstract
BackgroundThe introduction of the European Working Time Directive (EWTD) has greatly reduced training hours of surgical residents, which translates into 30% less surgical and clinical experience. Such a dramatic drop in attendance has serious implications such compromised quality of medical care. As the surgical department of the University of Heidelberg, our goal was to establish a model that was compliant with the EWTD while avoiding reduction in quality of patient care and surgical training.MethodsWe first performed workload analyses and performance statistics for all working areas of our department (operation theater, emergency room, specialized consultations, surgical wards and on-call duties) using personal interviews, time cards, medical documentation software as well as data of the financial- and personnel-controlling sector of our administration. Using that information, we specifically designed an EWTD-compatible work model and implemented it.ResultsSurgical wards and operating rooms (ORs) were not compliant with the EWTD. Between 5 pm and 8 pm, three ORs were still operating two-thirds of the time. By creating an extended work shift (7:30 am-7:30 pm), we effectively reduced the workload to less than 49% from 4 pm and 8 am, allowing the combination of an eight-hour working day with a 16-hour on call duty; thus, maximizing surgical resident training and ensuring patient continuity of care while maintaining EDTW guidelines.ConclusionA precise workload analysis is the key to success. The Heidelberg New Working Time Model provides a legal model, which, by avoiding rotating work shifts, assures quality of patient care and surgical training.
Highlights
The introduction of the European Working Time Directive (EWTD) has greatly reduced training hours of surgical residents, which translates into 30% less surgical and clinical experience
According to the EWTD, the average workload over 49% should be limited to eight hours followed by a 16-hour working period with an average workload of less than 49%
The detailed workload analysis indicated a need for workload reduction of the on-call team between 4 pm and 8 am to meet EWTD requirements since the workload of this time period was around 80%, which caused an average workload of more than 49% between 3.51 pm and 8 am
Summary
As the surgical department of the University of Heidelberg, our goal was to establish a model that was compliant with the EWTD while avoiding reduction in quality of patient care and surgical training. Our goal was to establish a more structured approach that balanced the consideration of both trainer and trainee—one that provided maximum flexibility for surgeons yet was in accordance with the restrictions set forth by the European Working Time Directive. The Heidelberg new working time model In order to maintain high quality patient care and to minimize errors due to frequent shift changes, our goal was to establish an EWTD-compliant New Working Time Model that minimized handovers and provided maximal flexibility regarding working time for surgeons
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