# Task Sharing in Neurosurgical Care Under Japan’s Work-Style Reform: A Collaboration With Nursing Designated Care (NDC) in Subarachnoid Hemorrhage Management

## TL;DR

This study examines how assigning a nursing designated care (NDC) nurse to a neurosurgery department helps redistribute tasks and improve efficiency in treating subarachnoid hemorrhage under Japan's work-style reforms.

## Contribution

The paper introduces a practical model of task sharing between neurosurgeons and NDC nurses to adapt to Japan's physician work-style reforms.

## Key findings

- Assigning an NDC nurse allowed redistribution of perioperative tasks in subarachnoid hemorrhage management.
- NDC involvement in the ER potentially shortened the time from treatment initiation to operating room admission.
- NDC nurses could assist in managing cerebral vasospasm, sharing duties with neurosurgeons.

## Abstract

Beginning in April 2024, work-style reforms were implemented for doctors. We analyzed the changes in our medical practice resulting from the assignment of a designated care nurse, called nursing designated care (NDC), to the Department of Neurosurgery, in line with work-style reforms. This study aimed to evaluate whether introducing an NDC into a neurosurgical department could redistribute perioperative tasks and improve workflow efficiency in subarachnoid hemorrhage (SAH) management under Japan’s physician work-style reforms. We compared medical care over a one-year period from April 2022, when our department had three neurosurgeons, and over a one-year period from April 2023, under a new system in a four-member team consisting of three neurosurgeons and one NDC. The target disease was a SAH. We compared medical care from initial treatment in the emergency room (ER) to the operating room, medical care from leaving the operating room to postoperative management after returning to the intensive care unit, and management of the cerebral vasospasm phase. Some of the work that had been performed by the neurosurgeons was taken over by the NDC, and the duties of the neurosurgeons were shared. Clinical intervention by the NDC in the ER for patients with SAH may contribute to shortening the treatment time from the start of treatment in the ER to admission in the operating room. In the management of the cerebral vasospasm phase, the NDC was able to intervene with multiple specified acts, and the neurosurgeon's duties were shared. We introduced our department's current treatment methods in line with the work-style reforms for doctors. Through collaboration with the NDC, it may be possible to divide work in line with the work-style reforms for neurosurgeons.