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

Hsu NC, Yang MC, Chang RE, Ko WJ - BMC Health Serv Res (2014)

Bottom Line: 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.Beyond work hours and patient census, patients with different clinical severity and palliative goal produce different workload for on-call residents.

View Article: PubMed Central - PubMed

Affiliation: Division of Hospital Medicine, Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan. chesthsu@gmail.com.

ABSTRACT

Background: Although 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.

Methods: A 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.

Results: From 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.

Conclusion: Beyond work hours and patient census, patients with different clinical severity and palliative goal produce different workload for on-call residents.

No MeSH data available.


Related in: MedlinePlus

Time distribution of night shift calls.
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Fig1: Time distribution of night shift calls.

Mentions: Figure 1 depicts the distribution of 841 calls (the time records were missing for 6 of the calls) on an hourly basis throughout the night shift. Two peaks, at 0-2 am and 6-7 am, were noted. The variation was more prominent for stable and DNR codes than for the unstable code, for which the rate of the calls remained almost constant throughout the night shift.Figure 1


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

Hsu NC, Yang MC, Chang RE, Ko WJ - BMC Health Serv Res (2014)

Time distribution of night shift calls.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4260207&req=5

Fig1: Time distribution of night shift calls.
Mentions: Figure 1 depicts the distribution of 841 calls (the time records were missing for 6 of the calls) on an hourly basis throughout the night shift. Two peaks, at 0-2 am and 6-7 am, were noted. The variation was more prominent for stable and DNR codes than for the unstable code, for which the rate of the calls remained almost constant throughout the night shift.Figure 1

Bottom Line: 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.Beyond work hours and patient census, patients with different clinical severity and palliative goal produce different workload for on-call residents.

View Article: PubMed Central - PubMed

Affiliation: Division of Hospital Medicine, Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan. chesthsu@gmail.com.

ABSTRACT

Background: Although 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.

Methods: A 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.

Results: From 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.

Conclusion: Beyond work hours and patient census, patients with different clinical severity and palliative goal produce different workload for on-call residents.

No MeSH data available.


Related in: MedlinePlus