Patient work load and doctor hours in a Norwegian university hospital department

Abstract

Background: Although clinical hospital departments are 24/7 operations, doctor staffing is mainly concentrated during day-time on weekdays, while the rest of the week is covered by on-call systems to secure a minimum of patient care throughout the week. Few studies have investigated how this affects the relation between units of service (UOS) and available doctor hours.

Methods: The study was carried out in a paediatric department with a neonatal intensive care section at a university hospital. Sixty per cent of the admissions were emergency cases. The organization of the 24/7 operation of the department is considered to be representative for most university hospital departments in Norway. OUS were calculated from the average number of in-hospital patients, out-patient consultations, the number of admissions and discharges during three defined time-periods: daytime, evening and night, assuming that all these doctor-patient contacts had the same impact on time use. Gross and net doctor hours on day-time during weekdays, on evenings, nights and weekends were calculated from work schedules, corrected for approved absence and long time sick leave. UOS per hour was calculated as the ratio between UOS and available gross and net doctor hours.

Results: Both available doctor hours as well as UOS per hour varied considerably throughout the week. Eighty-three per cent of doctor hours were concentrated on day-time during weekdays, representing only 24% of week hours. Evenings and nights representing 76% of weekly hours, were covered with only 17% of doctor hours, and all nights through the week and weekend evenings, representing 55% of weekly hours, were covered with only 7% of total doctor hours available. Gross and net OUS per hour was increased six-fold and three-fold respectively at day-time on weekends compared to day-time during weekends. Evenings and nights had an even higher UOS per hour.

Conclusion: The distribution of doctor hours through the week does not match UOS per hour. The high work load during weekends, evenings and nights are probably negative for the quality in patient treatment as well as for doctors work conditions. The department is probably understaffed during these time periods. It can also be asked if the department is overstaffed during day-time on weekdays. A more even and balanced staffing of hospital departments in relation to patient work load seems necessary in relation to quality in patient treatment, doctors' working conditions and productivity.