Résumé
Background: The “work style reform of physicians” is due to come into effect in April 2024. Cardiovascular surgery involves many life-saving surgeries after hours, and it is expected to be difficult to achieve the upper limit (level A) of 960 h per year and less than 100 h per month for overtime work. In 2021, there were five full-time cardiovascular surgeons, four of whom were responsible for performing emergency surgery for acute aortic dissection in our facility. The ability to provide emergency surgical care with any two-person combination increases the flexibility of staffing for routine surgery or after-hours on-call. The working environment and surgical outcomes of acute aortic dissection under this system are reported, and changes in work style in cardiovascular surgery are discussed. Methods: The surgical outcomes of 39 cases of acute aortic dissection requiring emergency open heart surgery at this hospital during the one-year period from January to December 2021 were investigated. The number of cases (and first assistants) performed by five full-time surgeons were 7(13), 9(6), 12(3), 11(7) and 0(10), respectively. In addition, there were 8 cases of acute aortic dissection requiring urgent stent graft treatment during the same period. The emergency response rate for emergency patients (including those other than acute aortic dissection) was 100% during the same period. Results: The age was 69 years (median), 48.7% were female, 92.3% were Stanford type A, of which 22.2% were DeBakey type II. Shock vital 20.5%, malperfusion 30.8%. The surgical procedures included TAR in 19 cases, PAR in 8 cases, HAR in 12 cases (including 2 Bentall). Concomitant operations were AVR in 5 cases, CABG in 2 cases, TEVAR in 1 case, lower limb arterioplasty in 2 cases and right hemispherectomy in 1 case. Operating time 400 min (median), extracorporeal circulation time 194 min (median), cardiac arrest 108 min (median), selective cerebral perfusion time 125 min (median), lower body circulation arrest 46 min (median). Hospital mortality 7.7%, stroke 12.8%, delayed paraparesis 2.6%. Ventilation time was 1 day (median), hospital stay 23 days (median), 64.1% were discharged at home. Working Environments: 12-13 on-calls per month. Maximum yearly overtime work is 480.5 h with full overtime pay. Exemptions from working after night shift were also possible. Conclusions: The surgical outcomes of acute aortic dissection at our hospital were acceptable. Not having a fixed surgeon enabled a flexible emergency response, and increased the flexibility of staffing for routine surgery and on-call, and was considered to enable both a change in working style and surgical safety while meeting the needs of the community.
Résumé
Introduction: Work style reform of medical doctors is now an actively discussed matter in Japan. There is also the problem of how to balance the management of legal working hours and the value of medical education in junior residency programs. In particular night and holiday shifts in emergency departments are one of the most important causes of working hour elongation for junior residents. We tried to construct a legally appropriate management method to control their working hours including night and holiday shifts. Method: One-Month Variable Working Hours System and two-shift system were applied to labor management in the medical residency program. Night and holiday working hours were included in regular working hours. Day-time working hours were adjusted to the weekly schedule of each clinical department to cover most of its daily work. Result: Overtime working hours of all residents, including the night and holyday shifts, were managed within the legal limits of 45 hours a month, unless additional overtime work was required. Discussion: Managing worktime through the use of the One-Month Variable Working Hours System is thought to be feasible. In the junior residency program, night and holiday shifts in the emergency department could also be balanced.
Résumé
We investigated how cardiovascular surgeons get a day off.
Résumé
We, a group of four delegates from Japan, participated in the fifth Japan-UK Primary Care Exchange Programme and visited the UK in October of 2018. This report highlights some differences between the UK and Japanese healthcare systems, such as working conditions for GPs and requirements for GP trainers, and what the Japan Primary Care Association can learn from them. We propose that the Japan Primary Care Association create opportunities to discuss and exchange views with other healthcare professionals, strengthen training programs for future GP trainers and define competencies for GP trainers in Japan.