title: Maximizing time from the constraining European Working Time Directive (EWTD): The Heidelberg New Working Time Model.
abstract: BACKGROUND
  The introduction of the European Working Time Directive (EWTD) has greatly reduced training hours of surgical residents, which translates into 30% less surgical and clinical experience. Such a dramatic drop in attendance has serious implications such compromised quality of medical care. As the surgical department of the University of Heidelberg, our goal was to establish a model that was compliant with the EWTD while avoiding reduction in quality of patient care and surgical training.
  
  
  METHODS
  We first performed workload analyses and performance statistics for all working areas of our department (operation theater, emergency room, specialized consultations, surgical wards and on-call duties) using personal interviews, time cards, medical documentation software as well as data of the financial- and personnel-controlling sector of our administration. Using that information, we specifically designed an EWTD-compatible work model and implemented it.
  
  
  RESULTS
  Surgical wards and operating rooms (ORs) were not compliant with the EWTD. Between 5 pm and 8 pm, three ORs were still operating two-thirds of the time. By creating an extended work shift (7:30 am-7:30 pm), we effectively reduced the workload to less than 49% from 4 pm and 8 am, allowing the combination of an eight-hour working day with a 16-hour on call duty; thus, maximizing surgical resident training and ensuring patient continuity of care while maintaining EDTW guidelines.
  
  
  CONCLUSIONS
  A precise workload analysis is the key to success. The Heidelberg New Working Time Model provides a legal model, which, by avoiding rotating work shifts, assures quality of patient care and surgical training.
authors.affiliation: University Hospital of General, Visceral and Transplantation Surgery of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany.
authors.forename: Simon
authors.initials: S
authors.lastname: Schimmack
authors.affiliation: Biomathematician, University Hospital of General, Visceral and Transplantation Surgery of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Hinz
authors.affiliation: Clinic Management, University Hospital of Heidelberg, Im Neuenheimer Feld 672, Heidelberg, 69120, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Wagner
authors.affiliation: University Hospital of General, Visceral and Transplantation Surgery of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schmidt
authors.affiliation: University Hospital of General, Visceral and Transplantation Surgery of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Strothmann
authors.affiliation: University Hospital of General, Visceral and Transplantation Surgery of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany.
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.affiliation: University Hospital of General, Visceral and Transplantation Surgery of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany.
authors.forename: Hubertus
authors.initials: H
authors.lastname: Schmitz-Winnenthal
keywords: EWTD; European working time directive; Heidelberg; Surgical training; Working time model; Workload analysis