地方公立基幹病院における医師の働き方改革に向けた取り組み

Reformation of Working Style in Thoracic Surgery Department

2024年4月から医師の働き方改革が始まった．長時間労働の改善が求められている一方，医療の質と安全の担保もまた重要である．当院は呼吸器外科常勤医師2名体制の公立基幹病院であり，本稿では限られた人員の中で遂行している，働き方改革に関する三つの取り組みを報告する．

Background：In April 2024, we aimed to reform the physicians’ working style in our hospital, which is a core regional hospital where only two full-time thoracic surgeons work. We report three efforts to enhance productivity despite of limited number of staff in the department of thoracic surgery.

Efforts：1）A new on-call system for thoracic surgery was introduced in April, 2024. To reduce the burden of on-call, we designated certain days when the on-call service is unavailable, where as the minimum level of medical care is ensured by transporting patients to other hospitals on those days. 2）The postoperative critical pathway and task shifting are promoted in collaboration with nurses. Task shifting is implemented by enhancing co-medical education to reduce work and establish a safe system for early discharge. 3）A critical pathway for the outpatient follow-up system is being promoted. We built up an outpatient follow-up system with collaborating medical clinics and hospitals. The application rate of the system was 73.1％, indicating that reduces the burden of outpatient work and promotes functional differentiation.

Conclusion：Establishing a sustainable medical system in collaboration with other departments, local medical institutions and residents is crucial in enhancing productivity with limited staff in the thoracic surgery department.