働き方改革に向けた地方大学心臓血管外科の取り組み

System Changes to Carry Out Working-style Reforms at Department of Cardiovascular Surgery of the Local University Hospital

2024年度より医師の働き方改革が実施された．心臓血管外科は緊急手術，術後管理などにより，年間960時間，月100時間未満の時間外労働の上限（A水準）の達成が困難な状況にある．また，働き方改革を推進しなければいけない一方で，その結果治療成績が下がるという状況は許されない．

Background：The “work style reform” started in April 2024. Our hospital has actively begun implementing task shifts. This study aimed to investigate changes in the surgical outcomes and work hours of cardiovascular surgeons resulting from the introduction of task shifting.

Patients and methods：A comparative study was conducted between January 2020 and December 2022, when task shifting was actively introduced, on cardiac surgery outcomes in patients aged 75 years and older, and perioperative risk scores （EuroSCOREⅡ, JapanSCORE2）. Changes in the working status of the cardiovascular surgeons were also examined.

Results：In total, 95 patients aged≧75 years who underwent cardiac surgery were enrolled. EuroSCOREⅡ was 3.9％ and the mortality rate by JapanSCORE2 was 3.7％, respectively. One case of 30-day mortality and four hospital deaths occurred. The median intensive care unit （ICU） and postoperative hospital stays were 3.0 and 24 days. Given the introduction of semiclosed ICU, medical work office assistants, and nurse practitioners, the hospital stay of cardiac surgeons decreased from 207 to 185 hours, and overtime work decreased from 64 to 41 hours.

Conclusion：Our efforts toward “work style reform” can currently reduce overtime without degrading surgical outcomes. However, there is still room for improvement, and further reforms are necessary.