Work Characteristics of Acute Care Surgeons at a Swiss Tertiary Care Hospital: A Prospective One‐Month Snapshot Study

Martinelli, Claudine Di Pietro; Haltmeier, Tobias; Lavanchy, Joël L.; Perrodin, Stéphanie; Candinas, Daniel; Schnüriger, Beat

doi:10.1007/s00268-021-06350-7

Cited by 4 publications

(4 citation statements)

References 31 publications

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“…The responsibilities of the surgical on-call team are multiple and highly relevant to the overall hospital system [ 20 ]. Besides the surgical skills in emergency and elective cases, knowledge regarding initial evaluation of acute surgical patients, ICU relevant topics and non-operative treatment strategies are required to overcome this unique role of in-house troubleshooting.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of emergency general surgery services in Switzerland: a nationwide survey

Quaile

Perrodin

Trippel

et al. 2023

Eur J Trauma Emerg Surg

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Objective Running an emergency general surgery (EGS) service is challenging and requires significant personnel and institutional resources. The aim of this study was to achieve a nationwide overview of the individual EGS service organizations in public hospitals in Switzerland. Methods All Swiss public hospitals with a surgical and emergency department were included and contacted by telephone. General surgeons were interviewed between December 2021 and January 2022 using a standardized questionnaire. Results Seventy-two out of 79 public hospitals in Switzerland (91.1%) agreed to the survey. They employed 1,581 surgeons in 19 (26.4%) hospitals with < 100 beds, 39 (54.2%) hospitals with 100–300 beds, 7 (9.7%) with 300–600 beds, and 7 (9.7%) with > 600 beds. The median number of surgeons per hospital was 20.5 (IQR 13.0–29.0). Higher level of care (intermediate or intensive care unit) was significantly less available in small hospitals (< 100 beds). The median hour of designated emergency operating room capacity per day was 14 h (IQR 14–24) for all hospitals with < 600 beds and 24 h (IQR 14–24) for the largest hospitals (> 600 beds). With increasing hospital size, there was a significant increase in the number of surgical units where EGS and orthopedic trauma surgery were covered by two separate teams (21.1% vs. 43.6% vs. 85.7% vs. 100%, p = 0.035). The median number of surgeons on-call per hospital and per 24 h was 5.0 (IQR 3.3–6.0). Conclusion Lack of higher level of care in small hospitals, limited emergency OR capacity and short rotations of on-call teams are major drawbacks of many current EGS systems in Switzerland. Centralization of critically ill EGS patients and reorganization of surgical on-call systems to designated acute care surgery teams should be considered.

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Section: Discussionmentioning

confidence: 99%

Characteristics of emergency general surgery services in Switzerland: a nationwide survey

Quaile

Perrodin

Trippel

et al. 2023

Eur J Trauma Emerg Surg

Self Cite

View full text Add to dashboard Cite

show abstract

“…The responsibilities of the surgical on-call team are multiple and highly relevant to the overall hospital system [20]. Besides the surgical skills in emergency and elective cases, knowledge regarding initial evaluation of acute surgical patients, ICU relevant topics and non-operative treatment strategies are required to overcome this unique role of inhouse troubleshooting.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of emergency general surgery services in Switzerland: A nationwide survey

Quaile

Perrodin

Trippel

et al. 2022

British Journal of Surgery

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Objective Running emergency general surgery (EGS) services is challenging and requires significant personnel and institutional resources. In addition, increasing specialization of surgeons has made the provision of EGS services more problematic. The aim of this study was to elaborate a nationwide overview of the individual hospital organization systems of EGS services in Switzerland and to find related challenges and difficulties. Methods Telephone based standardized survey of all Swiss hospitals with a state medical treatment contract of the Swiss Federal Office of Public Health (FOPH) including a surgical and emergency unit (ER). The telephone interviews were conducted between December 2021 and January 2022. A corresponding junior, senior consultant or attending surgeon was interviewed per hospital by one of four interviewers. Descriptive and univariate analysis was performed using SPSS Version 28. Results A total of 72 of 79 (91.1%) surgical clinics participated in the telephone survey. There were 19 (26.4%) hospitals with <100 beds, 37 (54.2%) hospitals with 100–300 beds, 7 (9.7%) with 300–600 beds, and 7 (9–7%) with >600 beds. 57 (79.2%) hospitals have both, an ER and an intensive care unit (ICU). Eight (11.1%) hospitals have solely an intermediate care unit (IMC), 7 (9.7%) solely an ER. The average number of surgeons per hospital was proportional to the size of the hospital: 11.1±4.1 surgeons in hospitals <100 beds, 23.1±8.8 surgeons in hospitals with 100–300 beds, 29.1±10 surgeons in hospitals with 300–600 beds, and 37.7±9.4 surgeons in hospitals >600 beds. The percentage of surgical staff on EGS service per hospital was significantly higher in smaller hospitals (<100 beds), however, with a smaller number of surgeons on service per day. Regarding personal resources to run the EGS services, for hospitals with >300 beds similar person-days per month were found (159.7±24.7). Conclusion This study elaborates and characterises for the first time EGS services in Switzerland. Different EGS systems are in place and are related to the size of the hospitals. The individual EGS systems have been discussed regarding (1) surgical expertise, (2) continuity of treating surgical teams, (3) teaching and (4) optimization of personnel hospital resources. Moreover, based on these results, recommendations have been made to optimize EGS services.

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“…Beginning in 2005, the maximum allowable number of working hours was capped at 50 for both residents and attendings [25]. A total of six studies were found that sought to determine the effects of these changes [25][26][27][28][29][30].…”

Section: Working Conditions In Switzerlandmentioning

confidence: 99%

“…Finally, in order to form a more complete picture of daily clinical practice, Di Pietro et al analysed the variety of tasks completed by trainees during their time on call [30]. A relatively even distribution was observed, with participants dedicating approximately 1/3 of their time to operating, rounding on patients, and completing administrative tasks.…”

Section: Working Conditions In Switzerlandmentioning

confidence: 99%

The Introduction of a 42 + 4 Hour Work Week for Surgical Residents in Switzerland – a Stakeholder Analysis

Antony,

Kalkum,

et al. 2024

Preprint

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Background The Swiss national union of residents and attendings (VSAO) has voiced its desire for a transition to a 42 + 4h work week, in which 42h be focued on patient care with the remaining 4h be dedicated solely to training purposes. This could potentially result in a decrease of 20% in surgical education time. The current study seeks to address the issues involved in its implementation as well as possible compensatory mechanisms. Methods This mixed methods study seeks to clearly underline the challenges associated with the implementation of a 42 + 4h work week. First, the major stakeholders were identified and analysed via umbrella review. Thereafter, a classic stakeholder analysis was performed. Via morphological matrix, possible models for the implementation of a 42 + 4h work week were developed and evaluated. Finally, representatives from the identified stakeholder groups were interviewed and given the opportunity to provide feedback. Results A total of 26 articles were identified by the literature search and were used to identify the major stakeholders and issues involved in the implementation of the desired work hour regulation. Overall, these showed conflicting results with regard to the effect decreased working hours would have on surgical training and patient outcomes. In the end, the morphological matrix produced three feasible and desirable models for the implementation of a 42 + 4h work week. Each included compensatory mechanisms like auxiliary staff, reduction in administrative tasks, and a switch to EPAs. In their interviews, the stakeholders generally supported these solutions. Conclusion Given the increasing emphasis on the importance of a positive work-life balance, it seems inevitable that the next few years will see the introduction of a 42 + 4h work week in Switzerland. However, it is imperative that every effort be made to preserve the quality of training and patient care for the next generations. This will require the cooperation of all stakeholders in order to find workable solutions.

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Work Characteristics of Acute Care Surgeons at a Swiss Tertiary Care Hospital: A Prospective One‐Month Snapshot Study

Cited by 4 publications

References 31 publications

Characteristics of emergency general surgery services in Switzerland: a nationwide survey

Characteristics of emergency general surgery services in Switzerland: a nationwide survey

Characteristics of emergency general surgery services in Switzerland: A nationwide survey

The Introduction of a 42 + 4 Hour Work Week for Surgical Residents in Switzerland – a Stakeholder Analysis

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