title: Implementation of the European Working Time Directive in neurosurgery reduces continuity of care and training opportunities.
abstract: BACKGROUND
  Implementation of the European Working Time Directive (EWTD) raises questions about reduced surgical training opportunities and lost continuity of patient care. We studied the effect that the EWTD has had in these areas for residents in the neurosurgical unit at St. George's Hospital, London, UK.
  
  
  METHODS
  Case notes for 50 emergency and 50 elective operative admissions were randomly selected before and after implementation of an EWTD compliant resident roster (total, 200 episodes). Each was objectively scored for continuity of care from the operating surgeon. Rosters from 3 months before and after implementation were compared to assess training opportunities available.
  
  
  RESULTS
  A significant reduction was observed in continuity of emergency care following introduction of the EWTD compliant roster (P < 0.009). The same proportion of residents consented and operated on elective cases; however, a significant reduction in continuity of postoperative care was observed (P < 0.0001). Resident training opportunities were substantially affected with reduced involvement in outpatient (72% vs. 60%) and operating sessions (79% vs. 63%) with their nominated consultant.
  
  
  CONCLUSIONS
  The EWTD has had a marked adverse impact on continuity of care for neurosurgical patients at St. George's Hospital. Residents' training opportunities were reduced.
authors.affiliation: Academic Neurosurgery Unit, St George's University of London, Room 1.122 Jenner Wing, Cranmer Terrace, London, SW17 0RE, UK.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Maxwell
authors.forename: Matthew
authors.initials: M
authors.lastname: Crocker
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Jones
authors.forename: Dolin
authors.initials: D
authors.lastname: Bhagawati
authors.forename: Marios C
authors.initials: MC
authors.lastname: Papadopoulos
authors.forename: B Anthony
authors.initials: BA
authors.lastname: Bell
mesh_terms: D000046:Academic Medical Centers / Q000592:standards / Q000639:trends; D001291:Attitude of Health Personnel; D004493:Education / Q000592:standards / Q000639:trends; D004503:Education, Medical, Graduate / Q000592:standards / Q000639:trends*; D004632:Emergency Medical Services / Q000592:standards / Q000639:trends; D006801:Humans; D007396:Internship and Residency / Q000592:standards / Q000639:trends*; D009493:Neurosurgery / Q000193:education*; D010561:Personnel Staffing and Scheduling / Q000592:standards / Q000639:trends*; D011787:Quality of Health Care / Q000592:standards / Q000639:trends*; D013997:Time Factors; D006113:United Kingdom; D000078329:Workforce; D016526:Workload / Q000592:standards*