Patient severity matters for night-shift workload for internal medicine residents in Taiwan
Journal
BMC Health Services Research
Journal Volume
14
Journal Issue
1
Date Issued
2014
Author(s)
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. ? 2014 Hsu et al.
Subjects
After-hours care; Hospitalist; Resident; Workload
SDGs
Other Subjects
cohort analysis; controlled study; general practice; human; internal medicine; major clinical study; night; nurse; out-of-hours care; quantitative study; resident; Taiwan; vital sign; workload; acute disease; aged; clinical practice; female; internal medicine; male; medical education; middle aged; patient referral; prospective study; severity of illness index; statistics and numerical data; Taiwan; very elderly; workload; Acute Disease; Aged; Aged, 80 and over; Cohort Studies; Female; Humans; Internal Medicine; Internship and Residency; Male; Middle Aged; Practice Patterns, Physicians'; Prospective Studies; Referral and Consultation; Severity of Illness Index; Taiwan; Workload
Publisher
BioMed Central Ltd.
Type
journal article