APPENDIX
A HEART AND
LUNG TRANSPLANT
SURGEON'S
WORKING WEEK
There are no surgeons whose sole work is heart
and lung transplantation. Transplant work is over and above a
full commitment in general cardiothoracic surgery. Estimates from
the Job Planning Report of the Society of Cardiothoracic Surgeons
of Great Britain and Ireland (August 2003) and from transplant
centres give an indication of the out of hours work of
an adult heart and lung transplant surgeon:
- 3.5 to 13.8 hours transplant work
per week (depending on number of surgeons in the rota).
- 6.5-10.9 hours non-transplant cardiothoracic
work per week (one in six rota).
COMPUTER MODELLING
OF CONSULTANT
ROTAS
The tables below give examples of computer modelling
of EWTD compliant rotas. These models underestimate the
challenge, as they make no allowance for study leave and the professional
support activities defined in the new consultant contract. Both
rotas ensure immediate compensatory rest on the day after implantation
at night. The first example shows a compliant implantation rota
for nine consultant surgeons. Such a rota might be feasible
in a centre that can sustain enough non-transplant work to make
full use of the number of surgeons available. The second example
shows a compliant implantation rota for four surgeons.
It shows how many weekdays will have to be taken off to ensure
compliance, thus reducing greatly the availability of consultants
for non-transplant cardiothoracic work. Such a rota might be feasible
if surgeons did nothing other than transplant work.
MODELLING FOR EWTD COMPLIANCE: HEART AND
LUNG TRANSPLANTATION CONSULTANT'S IMPLANTATION ROTA
USING THE DOCTORS' ROSTERING SYSTEM (LONDON
AND SOUTH EAST REGIONAL ACTION TEAM)
Speciality: Cardio-thoracic Surgery (Transplant)
WORK PATTERN: nine consultant surgeons non-resident on-call.
Work Pattern Analysis-Actuals against
the Working Time Directive.
|
| EWTD Analysis | Actual
| Target | Comments
|
|
| Average weekly hours of work | 45:22
| 48:00 | Assumes six weeks annual leave.
|
| Following each work day, a 35 hour continuous rest in 7 days or a 59 hour continuous rest in 14 days
| OK | |
|
| 11 hrs continuous rest in any 24 hour period
| OK | |
|
|
WORK PATTERN
DETAILS
The tables below represent one permutation for one week's
on-call for nine consultant surgeons. The shaded area represents
on-call for implantation and other cardiothoracic work. The assumption
is that, when on non-resident call, the surgeon achieves eight
hours rest between 5pm and 9am and 12 hours rest per 24 hours
at the weekend. The hours worked in the week in this example are
less than the target of 48 hours because the modelling compensates
for extra on-call in weeks when a colleague is on leave.
|
| Surgeon | Mon
| Tues | Wed
| Thur | Fri
| Sat | Sun
|
|
| Mr1 | 08:00-08:00
| Zero Hours | 08:00-18:00
| 08:00-18:00 | 08:00-18:00
| | |
| Mr2 | 08:00-18:00
| 08:00-08:00 | Zero Hours
| 08:00-18:00 | 08:00-18:00
| 08:00-08:00 | 08:00-08:00
|
| Mr3 | Zero Hours
| 08:00-18:00 | 08:00-08:00
| Zero Hours | 08:00-18:00
| | |
| Mr4 | 08:00-18:00
| 08:00-18:00 | 08:00-18:00
| 08:00-08:00 | Zero Hours
| | |
| Mr5 | 08:00-18:00
| 08:00-18:00 | 08:00-18:00
| 08:00-18:00 | 08:00-08:00
| | |
| Mr6 | 08:00-18:00
| 08:00-18:00 | 08:00-18:00
| Zero Hours | 08:00-18:00
| | |
| Mr7 | 08:00-18:00
| Zero Hours | 08:00-18:00
| 08:00-18:00 | 08:00-18:00
| | |
| Mr8 | 08:00-18:00
| 08:00-18:00 | Zero Hours
| 08:00-18:00 | 08:00-18:00
| | |
| Mr9 | 08:00-18:00
| 08:00-18:00 | 08:00-18:00
| 08:00-18:00 | Zero Hours
| | |
|
COVER PROVIDED
BY THE
WORK PATTERN
|
| Hour | 0
| 1 | 2
| 3 | 4
| 5 | 6
| 7 | 8
| 9 | 10
| 11 | 12
| 13 | 14
| 15 | 16
| 17 | 18
| 19 | 20
| 21 | 22
| 23 |
|
| | |
| | | |
| | Mr
| 1 |
| | | |
| | | |
| | | |
| |
| Mr
| 3 |
| | | |
| | | |
| | | |
| | | |
| | | |
| |
| Mon | | |
| | |
| | | |
| | | |
| | | |
| | | |
| | |
| 1 | 1
| 1 | 1
| 1 | 1
| 1 | 1
| 8* | 8
| 8 | 8
| 8 | 8
| 8 | 8
| 8 | 8
| 1 | 1
| 1 | 1
| 1 | 1
|
| Mr
| 1 |
| | | |
| | | |
| | | |
| | | |
| | | |
| |
| | |
| | | |
| | Mr
| 2 |
| | | |
| | | |
| | | |
| |
| Tue | | |
| | |
| | | |
| | | |
| | | |
| | | |
| | |
| 1 | 1
| 1 | 1
| 1 | 1
| 1 | 1
| 7* | 7
| 7 | 7
| 7 | 7
| 7 | 7
| 7 | 7
| 1 | 1
| 1 | 1
| 1 | 1
|
| Mr
| 2 |
| | | |
| | | |
| | | |
| | | |
| | | |
| |
| | |
| | | |
| | Mr
| 3 |
| | | |
| | | |
| | | |
| |
| Wed | | |
| | |
| | | |
| | | |
| | | |
| | | |
| | |
| 1 | 1
| 1 | 1
| 1 | 1
| 1 | 1
| 7* | 7
| 7 | 7
| 7 | 7
| 7 | 7
| 7 | 7
| 1 | 1
| 1 | 1
| 1 | 1
|
| Mr
| 3 |
| | | |
| | | |
| | | |
| | | |
| | | |
| |
| | |
| | | |
| | Mr
| 4 |
| | | |
| | | |
| | | |
| |
| Thu | | |
| | |
| | | |
| | | |
| | | |
| | | |
| | |
| 1 | 1
| 1 | 1
| 1 | 1
| 1 | 1
| 7* | 7
| 7 | 7
| 7 | 7
| 7 | 7
| 7 | 7
| 1 | 1
| 1 | 1
| 1 | 1
|
| Mr
| 4 |
| | | |
| | | |
| | | |
| | | |
| | | |
| |
| Fri | | |
| | |
| | | Mr
| 5 |
| | | |
| | | |
| | | |
| |
| 1 | 1
| 1 | 1
| 1 | 1
| 1 | 1
| 7* | 7
| 7 | 7
| 7 | 7
| 7 | 7
| 7 | 7
| 1 | 1
| 1 | 1
| 1 | 1
|
| | |
| | | |
| | Mr
| 2 |
| | | |
| | | |
| | | |
| |
| Sat | Mr
| 5 |
| | | |
| | | |
| | | |
| | | |
| | | |
| |
| 1 | 1
| 1 | 1
| 1 | 1
| 1 | 1
| 1* | 1
| 1 | 1
| 1 | 1
| 1 | 1
| 1 | 1
| 1 | 1
| 1 | 1
| 1 | 1
|
| Mr
| 2 |
| | | |
| | | |
| | | |
| | | |
| | | |
| |
| Sun | | |
| | |
| | | |
| | | |
| | | |
| | | |
| | |
| 1 | 1
| 1 | 1
| 1 | 1
| 1 | 1
| 1* | 1
| 1 | 1
| 1 | 1
| 1 | 1
| 1 | 1
| 1 | 1
| 1 | 1
| 1 | 1
|
|
* No. of transplant surgeons available. The modelling
assumes that consultants never take leave at the same time. Numbers
of doctors available will be less in weeks when one is on leave.
MODELLING FOR EWTD COMPLIANCE: HEART AND LUNG TRANSPLANTATION
CONSULTANT'S IMPLANTATION ROTA
USING THE DOCTORS' ROSTERING SYSTEM (LONDON AND SOUTH
EAST REGIONAL ACTION TEAM)
SPECIALITY: Cardio-thoracic Surgery (Transplant) WORK
PATTERN: Four consultant surgeons non-resident on-call
WORK PATTERN
ANALYSIS—ACTUALS
AGAINST THE
WORKING TIME
DIRECTIVE
|
| EWTD Analysis | Actual
| Target | Comments
|
|
| Average weekly hours of work | 46:46
| 48:00 | Assumes six weeks annual leave.
|
| Following each work day, a 35 hour continuous rest in 7 days or a 59 hour continuous rest in 14 days
| OK | |
|
| 11 hrs continuous rest in any 24 hour period
| OK | |
|
|
WORK PATTERN
DETAILS
The tables below represent one possibility for one week's
on-call for four consultant surgeons. The shaded area represents
on-call for implantation and other cardiothoracic work. The assumption
is that, when on non-resident call, the surgeon achieves eight
hours rest between 5pm and 9am and 12 hours rest per 24 hours
at the weekend. The hours worked in the week in this example are
less than the target of 48 hours because the modelling compensates
for extra on-call in weeks when a colleague is on leave.
|
| Surgeon | Mon
| Tues | Wed
| Thur | Fri
| Sat | Sun
|
|
| Mr1 | 08:00-08:00
| Zero Hours | 08:00-18:00
| 08:00-18:00 | Zero Hours
| 08:00-08:00 | 08:00-08:00
|
| Mr2 | 08:00-18:00
| 08:00-08:00 | Zero Hours
| 08:00-18:00 | 08:00-18:00
| | |
| Mr3 | Zero Hours
| 08:00-18:00 | 08:00-08:00
| Zero Hours | 08:00-08:00
| | |
| Mr4 | 08:00-18:00
| 08:00-18:00 | 08:00-18:00
| 08:00-08:00 | Zero Hours
| | |
|
COVER PROVIDED
BY THE
WORK PATTERN
|
| Hour | 0
| 1 | 2
| 3 | 4
| 5 | 6
| 7 | 8
| 9 | 10
| 11 | 12
| 13 | 14
| 15 | 16
| 17 | 18
| 19 | 20
| 21 | 22
| 23 |
|
| | |
| | | |
| | Mr
| 1 |
| | | |
| | | |
| | | |
| |
| Mr
| 2 |
| | | |
| | | |
| | | |
| | | |
| | | |
| |
| Mon | | |
| | |
| | | |
| | | |
| | | |
| | | |
| | |
| 1 | 1
| 1 | 1
| 1 | 1
| 1 | 1
| 3* | 3
| 3 | 3
| 3 | 3
| 3 | 3
| 3 | 3
| 1 | 1
| 1 | 1
| 1 | 1
|
| M |
1 | |
| | |
| | | |
| | | |
| | | |
| | | |
| |
| Tue | | |
| | |
| | | Mr
| 2 |
| | | |
| | | |
| | | |
| |
| 1 | 1
| 1 | 1
| 1 | 1
| 1 | 1
| 3* | 3
| 3 | 3
| 3 | 3
| 3 | 3
| 3 | 3
| 1 | 1
| 1 | 1
| 1 | 1
|
| Mr
| 2 |
| | | |
| | | |
| | | |
| | | |
| | | |
| |
| Wed | | |
| | |
| | | Mr
| 3 |
| | | |
| | | |
| | | |
| |
| 1 | 1
| 1 | 1
| 1 | 1
| 1 | 1
| 3* | 3
| 3 | 3
| 3 | 3
| 3 | 3
| 3 | 3
| 1 | 1
| 1 | 1
| 1 | 1
|
| Mr
| 3 |
| | | |
| | | |
| | | |
| | | |
| | | |
| |
| Thu | | |
| | |
| | | Mr
| 4 |
| | | |
| | | |
| | | |
| |
| 1 | 1
| 1 | 1
| 1 | 1
| 1 | 1
| 3* | 3
| 3 | 3
| 3 | 3
| 3 | 3
| 3 | 3
| 1 | 1
| 1 | 1
| 1 | 1
|
| | |
| | | |
| | Mr
| 3 |
| | | |
| | | |
| | | |
| |
| Fri | | |
| | |
| | | |
| | | |
| | | |
| | | |
| | |
| Mr
| 4 |
| | | |
| | | |
| | | |
| | | |
| | | |
| |
| 1 | 1
| 1 | 1
| 1 | 1
| 1 | 1
| 2* | 2
| 2 | 2
| 2 | 2
| 2 | 2
| 2 | 2
| 1 | 1
| 1 | 1
| 1 | 1
|
| | |
| | | |
| | Mr | 1
| | | |
| | | |
| | | |
| | |
| Sat | Mr
| 3 |
| | | |
| | | |
| | | |
| | | |
| | | |
| |
| 1 | 1
| 1 | 1
| 1 | 1
| 1 | 1
| 1* | 1
| 1 | 1
| 1 | 1
| 1 | 1
| 1 | 1
| 1 | 1
| 1 | 1
| 1 | 1
|
| Mr
| 1 |
| | | |
| | Mr
| 1 |
| | | |
| | | |
| | | |
| |
| Sun | | |
| | |
| | | |
| | | |
| | | |
| | | |
| | |
| 1 | 1
| 1 | 1
| 1 | 1
| 1 | 1
| 1* | 1
| 1 | 1
| 1 | 1
| 1 | 1
| 1 | 1
| 1 | 1
| 1 | 1
| 1 | 1
|
|
* No of transplant surgeons available. The modelling
assumes that consultants never take leave at the same time. Numbers
of doctors available will be less in weeks when one is on leave.
| 
