Impact of Enforcement of the Act to Improve Training Conditions and the Status of Medical Residents in Emergency Abdominal Surgery
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: In 2018, the Act to Improve Training Conditions and the Status of Medical Residents (AITR) was fully implemented inSouth Korea. This study aimed to investigate the effects of AITR implementation on the clinical outcomes of patients who under went emergency abdominal surgery. Materials and Methods: A total of 2571 patients who underwent emergency abdominal surgery after visiting the emergencyroom (ER) between 2015 and 2019 was included. Electronic medical records were retrospectively reviewed. In addition, a com parative analysis was performed for patient groups treated before and after AITR implementation. Results: The median patient age was 48.0 years, and 49.2% of them were male. Appendicitis was the most common diagnosis(82.6%), followed by major abdominal emergencies (9.9%) and cholecystitis (7.5%). The median time from arrival to surgery was439 min, and 52 (2.0%) patients died. A comparison of patients who underwent surgery before (pre-AITR; 1453, 56.5%) and after(post-AITR; 1118, 43.5%) AITR implementation revealed a significant difference in age, number of residents on a 24-h shift, and di agnosis. The time from ER arrival to surgery was not significantly longer after AITR implementation than before AITR implementa tion (434 min vs. 443 min, p=0.230). AITR was not a significant risk factor for mortality (p=0.225). Conclusion: The time from ER arrival to emergency surgery did not increase significantly after AITR implementation, and therewas no difference in the patients’ clinical outcomes.
Abstract
Purpose: In 2018, the Act to Improve Training Conditions and the Status of Medical Residents (AITR) was fully implemented inSouth Korea. This study aimed to investigate the effects of AITR implementation on the clinical outcomes of patients who under went emergency abdominal surgery. Materials and Methods: A total of 2571 patients who underwent emergency abdominal surgery after visiting the emergencyroom (ER) between 2015 and 2019 was included. Electronic medical records were retrospectively reviewed. In addition, a com parative analysis was performed for patient groups treated before and after AITR implementation. Results: The median patient age was 48.0 years, and 49.2% of them were male. Appendicitis was the most common diagnosis(82.6%), followed by major abdominal emergencies (9.9%) and cholecystitis (7.5%). The median time from arrival to surgery was439 min, and 52 (2.0%) patients died. A comparison of patients who underwent surgery before (pre-AITR; 1453, 56.5%) and after(post-AITR; 1118, 43.5%) AITR implementation revealed a significant difference in age, number of residents on a 24-h shift, and di agnosis. The time from ER arrival to surgery was not significantly longer after AITR implementation than before AITR implementa tion (434 min vs. 443 min, p=0.230). AITR was not a significant risk factor for mortality (p=0.225). Conclusion: The time from ER arrival to emergency surgery did not increase significantly after AITR implementation, and therewas no difference in the patients’ clinical outcomes.
참고문헌 (21)
- Rosenbaum L, "Residents’ duty hours--toward an empirical narrative", N Engl J Med, 367, pp.2044~2049 (2012)
- McNoble DJ, "Expanded liability of hospitals for the negligence of fatigued residents", J Leg Med, 11, pp.427~449 (1990)
- Whang EE, "Implementing resident work hour limitations : lessons from the New York State experience", Ann Surg, 237, pp.449~455 (2003)
- "Will sudden death of 9 years old boy lead to a new law for patient safety?"[URL]
- Hyeong Won Yu, "Implementation of a resident night float system in a surgery department in Korea for 6 months: electronic medical record-based big data analysis and medical staff survey", Annals of Surgical Treatment and Research, 96(5), pp.209~215 (2019), 대한외과학회[DOI]
- "Enforcement Regulations of the Act for Improving the Training Environment and Improving the Status of Medical resident"[URL]
- Rojin Heo, "Does work time limit for resident physician affect short-term treatment outcome and hospital length of stay in patients with spontaneous intracerebral hemorrhage?: a two-year experience at a single training hospital in South Korea", Journal of Cerebrovascular and Endovascular Neurosurgery, 22(4), pp.245~257 (2020), 대한뇌혈관외과학회
- Dong Jin Kim, "Comparative study of the operative experience of surgical residents before and after 80-hour work week restrictions", Annals of Surgical Treatment and Research, 95(5), pp.233~239 (2018), 대한외과학회
- Moon KM, "Resident working hour restrictions increased the workload of the medical emergency team : a retrospective observational study", J Patient Saf, 15, pp.e94~e97 (2019)
- Iglehart JK, "Revisiting duty-hour limits--IOM recommendations for patient safety and resident education", N Engl J Med, 359, pp.2633~2635 (2008)
- Poulose BK, "Resident work hour limits and patient safety", Ann Surg, 241, pp.847~856 (2005)
- Cappuccio F, "Sleep, health, and society : from aetiology to public health" (2010), Oxford University Press
- Dumon KR, "Surgical education in the new millennium : the European perspective", Surg Clin North Am, 84, pp.1471~1491 (2004)[DOI]
- Businger AP, "Resident work hour restrictions do not improve patient safety in surgery : a critical appraisal based on 7 years of experience in Switzerland", Patient Saf Surg, 6, pp.17~ (2012)
- Denson JL, "Increased mortality rates during resident handoffperiods and the effect of ACGME duty hour regulations", Am J Med, 128, pp.994~1000 (2015)
- Bilimoria KY, "National cluster-randomized trial of duty-hour flexibility in surgical training", N Engl J Med, 374, pp.713~727 (2016)
- Silber JH, "Patient safety outcomes under flexible and standard resident dutyhour rules", N Engl J Med, 380, pp.905~914 (2019)
- Moonesinghe SR, "Impact of reduction in working hours for doctors in training on postgraduate medical education and patients’ outcomes : systematic review", BMJ, 342, pp.d1580~ (2011)
- Jamal MH, "Systematic review and meta-analysis of the effect of North American working hours restrictions on mortality and morbidity in surgical patients", Br J Surg, 99, pp.336~344 (2012)
- Landrigan CP, "Effect on patient safety of a resident physician schedule without 24-hour shifts", N Engl J Med, 382, pp.2514~2523 (2020)
- Carpenter RO, "Work hours restrictions as an ethical dilemma for residents : a descriptive survey of violation types and frequency", Curr Surg, 63, pp.448~455 (2006)