Patient severity matters for night-shift workload for internal medicine residents in Taiwan.

Nin-Chieh Hsu,Wen-Je Ko,Ray-E Chang,Ming-Chin Yang

doi:10.1186/s12913-014-0587-0

Abstract

BackgroundAlthough work hour is an important factors for resident workload, other contributing factors, such as patient severity, with regards to resident workload have been scarcely studied.MethodsA prospective observational cohort study was conducted in a general medicine unit in an academic medical center in Taiwan. Every event for which the nurses needed to call the on-call residents was recorded. To quantify the workload, the responses of on-duty residents to calls were analyzed. To allow comparisons of patient factors to be made, we classified all patients by assigning them stable, unstable, or do-not-resuscitate (DNR) codes. The reasons for the calls were categorized to facilitate the comparisons across these three groups.ResultsFrom October 2009 to September 2011, a total of 2,518 patients were admitted to the general medicine unit. The nurses recorded a total of 847 calls from 730 call nights, ranging from 0 to 7 per night. Two peaks of calls, at 0-2 am and 6-7 am, were noted. Calls from stable, unstable, and DNR patients were 442 (52.2%), 95 (11.2%), and 298 (35.2%), respectively. For both unstable and DNR patients, the leading reason was abnormal vital signs (62.1% and 67.1%, respectively), while only 36.2% for stable patients. Both unstable and DNR patients required more bedside evaluation and management compared to stable patients.ConclusionBeyond work hours and patient census, patients with different clinical severity and palliative goal produce different workload for on-call residents.

Highlights

Work hour is an important factors for resident workload, other contributing factors, such as patient severity, with regards to resident workload have been scarcely studied
In order to contribute to the groundwork of establishing reasonable on-call workload, our research aims to study the night-shift workload for residents and focuses on the reasons of placing calls at night, and the patient sources of calls and workload produced after the calls
Night shift calls From October 2009 to September 2011, a total of 2518 patients were admitted to the hospitalist ward

Summary

Introduction

Work hour is an important factors for resident workload, other contributing factors, such as patient severity, with regards to resident workload have been scarcely studied. The main workload during on-call shifts includes caring for previously admitted patients and managing new admissions, if any [2]. To improve residents’ health, it is reasonable to reduce the night workload as much as possible, unless this could compromise patient safety or quality of care [8]. The reasons of calling onduty residents have been extensively studied in several different settings, but the sources of calls which could be helpful in predicting workload were rarely mentioned. Calls from stable, critically ill patients, or patients in other special conditions, may led to different pattern of care

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Discussion

Conclusion