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Published on: October 24, 2020
Patient severity matters for night-shift workload for internal medicine residents in Taiwan
Nin-Chieh Hsu1,2,3, Ming-Chin Yang4, Ray-E Chang5
1Division of Hospital Medicine, Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan. chesthsu@gmail.com.
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.
