The negative effect of the work of travel is a matter that affects most physicians and may influence the safety of the patient. Therefore, it is necessary to design a voucher system rota which would help to ensure coverage of service 24/7, to minimize the risk of staff (doctors) and patients and improve the efficiency of the delivery of services.
Various studies have demonstrated that the shift may have several short-term and long-term medical effects. A Japanese study in a University Hospital has suggested that the practice continues and the large number of patients was correlated with increased medical errors. Short term effects may include fatigue, needle injuries, irritable colon syndrome, post travel accidents (RTA). Long-term effects include the increase in the incidence of cardiovascular disease, heart attack, stroke, deprivation of sleep and neurological disorders. The effects of long shifts are not felt only on health but on personal relations also.
A survey was conducted on intraoperative deaths by CEPOD linked UK medical errors with fatigue, sleep deprivation. In addition, it also identified the risks for the number of trips has worked. A reported adverse events at 6% on the second night, 17 per cent on the third and 36 per cent on the fourth night shift worked. The costs incurred by this neglect are also very high.
The key to minimize risk is to design rota good system to avoid too many hours for physicians on the rota. Providing good working conditions and facilities rest during movements can also help improve performance. Rooms on appeal should be available for the staff of night-work and be of sufficient standard to facilitate adequate rest breaks and automates rest. In addition, a Fatigue risk management system should be put in place in the hospital that provides care and support to physicians and other members of the medical staff.
The support of the management of the hospital, the masters of rota and senior doctors is required, and each of them could have their own point of view on this. Effective work of the bearing system can be difficult in medical emergencies, epidemics (swine flu) and natural disasters such as earthquakes, floods, etc. because of a large no. patients. Physicians and other members of the medical staff shall he fixed their schedules. Doctors must be more flexible with their work habits. Patients may have problems and would not be comfortable with other physicians during a specific shift. ("I want to see my doctor.")
Need: Increased demand in the practice of hospital led to the provision of services for 24 hours. Maj structure to intensive workload and may therefore result in fatigue and decreased performance. Good design rota can mitigate the risk of development of fatigue. Customer service could be improved and enhanced, removing gaps that it contains.
Customers: Doctors, Patients Local, visiting Patients and other members of the medical staff.
Costs: The authority of litigation NHS England paid £ 769 m in 2008/09 clinical negligence claims, compared with 633 million pounds in 2007/08. To reduce these costs. To be profitable by giving the value of money. The overall costs to implement the policy will be much cheaper than the expenditure of fees to cover the claims of clinical negligence.
Contest: Practitioners private, traditional healers, etc.. Medical workers that do not set shifts and are flexible.
Sufficient evidence is now concludes that shift work particularly outside the hours of travel is harmful to physicians; even in short term and can have a negative impact on the safety of the patient. As a result, many recommendations can be made: the lengths of travel should be as short as possible, rest breaks should be facilitated and encouraged doctors to rest for the night, as much as possible; and employers and workers should be educated as how circadian rhythms can be changed and thus maximize the vigilance to work, to minimize the risk to staff, patients and society as a whole.
Good design rota which provides service 24/7 coverage, maximize training opportunities and reducing to a minimum the adverse effects should be adopted. Proposal to develop a good system of rolling with a constructive approach, to minimize the adverse effects of long shifts and reduce medical errors. Design of system of rotation to be, 4 - 8 day trips, followed by quarter-7hrs-1 night and 2 days of rest and period. Movements of the doctor are arranged accordingly to provide service 24 hours. Avoid the displacement of more than 12 hours. A model of rota on traditional call 24 hr should be adopted for certain specialties.
The support of the management of the hospital, masters of rota and senior doctors will be essential and accepted by everyone in the system. Encourage the accurate and honest monitoring of rotas. Monitoring of effectiveness can be done using charts and line graphs to evaluate his work. Patients, physicians, and management comments are necessary. This improvement should be made available as soon as possible and should be immediately put into practice.
Dr. Jatin Kapadia. (Doctor spectrum)
The University of Sheffield. United Kingdom.
MSC Health Services management. Department of Management and SCHARR.
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