Maximizing time from the constraining European Working Time Directive (EWTD): The Heidelberg New Working Time Model

Abstract

Background: The introduction of the European Working Time Directive (EWTD) has greatly reduced training hours of surgical residents, which translates into 30% less surgical and clinical experience. Such a dramatic drop in attendance has serious implications such compromised quality of medical care. As the surgical department of the University of Heidelberg, our goal was to establish a model that was compliant with the EWTD while avoiding reduction in quality of patient care and surgical training.

Methods: We first performed workload analyses and performance statistics for all working areas of our department (operation theater, emergency room, specialized consultations, surgical wards and on-call duties) using personal interviews, time cards, medical documentation software as well as data of the financial- and personnel-controlling sector of our administration. Using that information, we specifically designed an EWTD-compatible work model and implemented it.

Results: Surgical wards and operating rooms (ORs) were not compliant with the EWTD. Between 5 pm and 8 pm, three ORs were still operating two-thirds of the time. By creating an extended work shift (7:30 am-7:30 pm), we effectively reduced the workload to less than 49% from 4 pm and 8 am, allowing the combination of an eight-hour working day with a 16-hour on call duty; thus, maximizing surgical resident training and ensuring patient continuity of care while maintaining EDTW guidelines.

Conclusion: A precise workload analysis is the key to success. The Heidelberg New Working Time Model provides a legal model, which, by avoiding rotating work shifts, assures quality of patient care and surgical training.

Keywords: EWTD; European working time directive; Heidelberg; Surgical training; Working time model; Workload analysis.

Figure 1

Working load analysis of operation theater. Operating rooms (ORs) that were running at full-time (or greater than 49% workload) during various time shifts: between 8 am and 4 pm, four ORs were running; until 8 pm, two; and until 2 am, one. The yellow line designates the critical 49% workload, which cannot be exceeded for more than 9.25 hours in a 24-hour period. The orange line denotes the workday that extends beyond the 13-hour EDTW guideline. The red arrows indicate the 9.25-hour period of full-time work.

Figure 2

Presence of emergency room surgeons on working days in 2007.

Figure 3

Heidelberg New Working Time Model (work days), implemented since October 2009.

Figure 4

Two examples of workload analyses after the implementation of the New Working Time Model. A: Surgical Fellow, B: Surgical Resident (emergency room). In total, the workload from 16:00 (4 pm) to 08:00 (8 am) was below 49% for both, thus giving the opportunity to combine a regular full-time working day with a 15.5-hour on-call duty. (X-axis: European time; y-axis: percent of work; Workload green: <25%; yellow: <50%; red: regular work >50%. This graph was created by the online software of ww2.gob-tauch.de.