醫師長工時/輪班與其個人健康及病患安全之文獻回顧

Abstract

台灣健保給付的制度及醫療糾紛、高風險、工時過長等因素使得醫師不斷流失，尤其是急重症的科別，本文整理國外文獻，以pubmed及medline資料庫為主，探討輪班與長工時對醫師身心理的影響，45篇與輪班及長工時有關之實驗性設計原始文獻，其中13篇文獻指出輪班及長工時造成神經功能降低，增加醫療錯誤率及增加意外事故發生率，4篇關於醫師輪值夜班後，對心血管功能的影響，2篇探討輪夜班之後，免疫功能降低，11篇文獻指出醫師工作壓力與過勞相關，另外15篇探討輪班與睡眠障礙、疲勞、情緒的關係，經回顧文獻發現，醫師輪班及長工時嚴重地影響個人健康、安全以及病患安全，國內雖已有減少醫師過勞之解決方案，但成效如何，未來仍需進一步評估，藉由文獻中許多實驗設計評估工具，其適用性可提供未來臨床評估，以及醫療體制改革之參考，使第一線醫療人員在醫治病患同時能兼顧健康及醫療品質。

Under the multiple pressure such as Taiwan’s health insurance regulations, medical disputes, work risks and long working hours, the physicians have been forced to leave the medical industry, especially those in the Emergency and Critical department. To shed light on the impact of work shifts and long working hours on the mental and physical health of physicians, the present study reviewed 45 experimental studies from the pubmed and medline database. Among the 45 studies, 13 indicated that work shifts and long working hours may affect the physicians’ nerve function, while increasing the rate of medical errors and accidents; 4 studies investigated the impact of work shifts on the physicians’ cardiovascular function; 2 examined the physicians’ immune function after night shifts; 11 discussed the working stress, and other 15 explored the sleep disorders, fatigue and emotions in relation to work shifts. Despite the fact that the solutions to the physicians' fatigue have been proposed, the effectiveness needs further investigations. Based on the literature reviews, it was found that the implications drawn from the empirical studies were applicabile for future clinical evaluation and health care system reform. In this way, Taiwan healthcare workers could ensure their own health while improving the quality of medical care.