Workload redistribution: a new approach to the 80-hour workweek.
BACKGROUND
The new Accreditation Council for Graduate Medical Education-mandated 80-hour resident work week has resulted in busy trauma services struggling to meet these strict guidelines, or face loss of accreditation.


METHODS
Beginning in July 2003, our Level I trauma service began a policy of direct admission of isolated neurosurgical or orthopedic injuries to the specific subspecialty service after complete evaluation by the trauma service in the emergency department for associated injuries. Complications, missed injuries, delayed diagnoses, and admission rates were compared in two 6-month periods: PRE, before the policy change; and POST, after the new policy had been instituted. Resident work hours were likewise compared over the two time periods.


RESULTS
Selected single-system injury admission to subspecialty services resulted in a 15% reduction in admissions to the trauma service. There were no significant differences in the overall complication rate, delayed diagnoses, or missed diagnoses between the PRE and POST time periods. Overall, there was a 9.7% reduction in resident work hours (p = 0.45; analysis of variance) between the PRE and POST periods, which allowed them, on average, to meet the Accreditation Council for Graduate Medical Education 80-hour workweek mandate.


CONCLUSIONS
Direct admission of patients with isolated injuries to subspecialty services is safe and decreases the workload of residents on busy trauma services.
Rogers
Frederick
F
Department of Surgery, University of Vermont College of Medicine, Burlington, Vermont 05401, USA. frederick.rogers@vtmednet.org
Shackford
Steven
S
Daniel
Subashini
S
Crookes
Bruce
B
Sartorelli
Kennith
K
Charash
William
W
Igneri
Peter
P
D017677:Age Distribution; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007396:Internship and Residency / Q000458:organization & administration* / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008511:Medicine / Q000458:organization & administration / Q000706:statistics & numerical data; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration* / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013038:Specialization; D014193:Trauma Centers / Q000458:organization & administration* / Q000706:statistics & numerical data*; D014194:Traumatology / Q000193:education; D014707:Vermont; D016526:Workload / Q000706:statistics & numerical data*