title: Patient severity matters for night-shift workload for internal medicine residents in Taiwan.
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.
  
  
  CONCLUSIONS
  Beyond work hours and patient census, patients with different clinical severity and palliative goal produce different workload for on-call residents.
authors.affiliation: Division of Hospital Medicine, Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan. chesthsu@gmail.com.|Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. chesthsu@gmail.com.|Institute of Health Policy and Management, College of Public Health, National Taiwan University, Rm.639, #17 Xu-Zhou Road, Taipei, Taiwan. chesthsu@gmail.com.
authors.forename: Nin-Chieh
authors.initials: NC
authors.lastname: Hsu
authors.affiliation: Institute of Health Policy and Management, College of Public Health, National Taiwan University, Rm.639, #17 Xu-Zhou Road, Taipei, Taiwan. mcyang637@ntu.edu.tw.
authors.forename: Ming-Chin
authors.initials: MC
authors.lastname: Yang
authors.affiliation: Institute of Health Policy and Management, College of Public Health, National Taiwan University, Rm.639, #17 Xu-Zhou Road, Taipei, Taiwan. rchang@ntu.edu.tw.
authors.forename: Ray-E
authors.initials: RE
authors.lastname: Chang
authors.affiliation: Division of Hospital Medicine, Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan. kowj@ntu.edu.tw.
authors.forename: Wen-Je
authors.initials: WJ
authors.lastname: Ko
mesh_terms: D000208:Acute Disease / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000706:statistics & numerical data*; D007396:Internship and Residency / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D013624:Taiwan; D016526:Workload / Q000706:statistics & numerical data*