title: [A new working shift model for anesthesiologists: an analysis 3 years after implementation].
abstract: OBJECTIVE
  The aim of this study was to assess the efficacy, appropriateness and cost-effectiveness of a new working shift model for anesthesiologists complying with the European working time directive (EWTD) at the University Hospital of Tübingen (UKT), Germany 3 years after implementation
  
  
  BACKGROUND
  Applying the standards of the EWTD is challenging for university hospitals as doctors must comply with the challenge of combining patient care, research and teaching. So far there have been no data available for German university hospitals on how these requirements can be met. As the department of anesthesiology is also a service-providing department it is essential not to increase staffing costs with a new shift model.
  
  
  METHODS
  In 2007 a new working shift model for the department of anesthesiology was designed and introduced in 2008. Shift planning and documentation of working hours were implemented electronically. The calculated number of doctors to run this model was 87.6 full time equivalents (FTE). For 2009 and 2010 the compliance with the EWTD parameters was checked for 1) average weekly working time limit (AWWTL) and 2) compliance to the maximum daily working time limit of 10 h (10 h DWTL). Furthermore, staffing costs for doctors in 2010 were compared to 2007. To check for the time spent in patient care the period of anesthetic attendance (PAA) was chosen, i.e. the total time of patient contact by anesthesiology staff. Data were analyzed descriptively for AWWTL and for 10 h DWTL. FTE, staff costs and PAA were evaluated by one-way ANOVA.
  
  
  RESULTS
  The new shift model allowed 84.4 % of all doctors to comply with the individual AWWT limits of 54 h and 48 h in 2009 (81/96) and 76.0 % in 2010 (79/104). In 2009 61.5 % of anesthesiologists voted for opt-out (59/96) and 53.8 % did so in 2010 (56/104). The 10 h DWTL was respected by 84.0 % in 2009 and by 85.9 % in 2010. The mean number of anesthesiologists rose significantly from 78.4 FTE in 2007 to 82.5 FTE in 2009 and 84.6 FTE in 2010 (p < 0.001 for 2010 vs. 2007, p = 0.004 for 2009 vs. 2007 and was not significant for 2010 vs. 2009). Staff costs per FTE increased from 7,524.79 <euro>/month to 7,800.66 <euro>/month and 7,966.11 <euro>/month in 2007, 2009 and 2010, respectively with the differences being non-significant. The PAA increased significantly from a mean of 6,124 h/month in 2007 to 6,581 h/month in 2009 and 6,872 h/month in 2010 (p < 0.001 for 2010 vs. 2007, whereas 2009 vs. 2007 and 2010 vs. 2009 were not significant). Thus, labour costs increased from 96.59 <euro>/h PAA in 2007 to 98.53 <euro>/h in both 2009 and 2010, the differences being not significant.
  
  
  CONCLUSIONS
  The newly designed shift model allowed a fair compliance with the EWTD in respect to AWTL and 10 h DWTL, although the calculated number of doctors to run the shift model could not be met in 2009 and 2010. Violations of the 10 h DWT limits were stable in 2009 and 2010; however the number of doctors exceeding the AWWT limits appeared to increase. The compliance with opt-out decreased from 2009 to 2010 and a high proportion of AWWTL violations resulted from the group of non-opt-out voters. The staff costs per hour PAA after implementation of the new shift model did not differ significantly from the year before although staffing costs increased by 7.2 % between 2007 and 2010. Costs increased by 162,454 <euro>/year for all PAA hours in 2010. Further evaluation of staff satisfaction with the new shift models is needed and already under way.
authors.affiliation: Stabsstelle für Medizinische Strukturplanung und Qualitätsmanagement, Universitätsklinikum Tübingen, Tübingen, Deutschland. jens.maschmann@med.uni-tuebingen.de
authors.forename: J
authors.initials: J
authors.lastname: Maschmann
authors.forename: M
authors.initials: M
authors.lastname: Holderried
authors.forename: G
authors.initials: G
authors.lastname: Blumenstock
authors.forename: M A
authors.initials: MA
authors.lastname: Rieger
authors.forename: M
authors.initials: M
authors.lastname: Bamberg
authors.forename: P
authors.initials: P
authors.lastname: Rosenberger
authors.forename: T
authors.initials: T
authors.lastname: Wagner
mesh_terms: D000704:Analysis of Variance; D000776:Anesthesiology / Q000191:economics / Q000639:trends; D005858:Germany; D006785:Hospitals, University; D006801:Humans; D017146:Models, Organizational; D010561:Personnel Staffing and Scheduling / Q000191:economics / Q000592:standards* / Q000639:trends; D010564:Personnel, Hospital; D010820:Physicians / Q000191:economics; D014940:Work Schedule Tolerance; D000078329:Workforce