RESIDENT DUTY HOURS- SUMMARY

DEPARTMENT OF ANESTHESIOLOGY

ACGME Common Program Requirements Effective July 1, 2011

 

The UTMB Anesthesiology program will be compliant with all ACGME Duty Hour Requirements. These requirements may be viewed in their entirety at http://www.acgme.org/acWebsite/dutyHours/dh_index.asp  or in the UTMB 2011-2012 GME Institutional Handbook, pages 51-57 at http://www.utmb.edu/gme/general/ .

 

 

1.      Maximum Hours of Work per Week

.......80 hours per week, averaged over a four week period, inclusive of all in-house call activities and all moonlighting (this includes internal “ Late Room” moonlighting). Moonlighting must not interfere with ability of resident to achieve goals and objectives of educational program. PGY-1 residents are not permitted to moonlight.

 

2.      Mandatory Time Free of Duty

.......Residents must be scheduled for a minimum of one day free of duty every week (when averaged over four weeks).  At-home call cannot be assigned on these free days.

 

3.      Maximum Duty Period Length

.......Duty periods of PGY-1 residents must not exceed 16 hours in duration.

.......Duty periods of PGY-2 residents and above may be scheduled to a maximum of 24 hours of continuous duty in the hospital. Programs must encourage residents to use alertness management strategies in the context of patient care responsibilities. Strategic napping, especially after 16 hours of continuous duty and between the hours of 10:00 p.m. and 8:00 a.m., is strongly suggested. Call rooms are available.

.......It is essential for patient safety and resident education that effective transitions in care occur.  Residents may be allowed to remain on-site in order to accomplish these tasks; however, this period of time must be no longer than an additional four hours.

.......Residents must not be assigned additional clinical responsibilities after 24 hours of continuous in-house duty.

 

4.      Duty Hour Exceptions:  The program director must review each submission of additional service, and track both individual resident and program-wide episodes of additional duty.

 

……In unusual circumstances, residents, on their own initiative, may remain beyond their      scheduled period of duty to continue to provide care to a single patient. Justifications for such extensions of duty are limited to reasons of required continuity for a severely ill or unstable patient, academic importance of the events transpiring, or humanistic attention to the needs of a patient or family.

Under those circumstances, the resident must:

appropriately hand over the care of all other patients to the team responsible for their continuing care; and, document the reasons for remaining to care for the patient in question and submit that documentation in every circumstance to the program director.

 

5.      Minimum Time Off between Scheduled Duty Periods

Anesthesiology schedules shall be planned such that all residents PGY 1-4 should have 10 hours free of duty between scheduled duty periods & those taking call have14 hours free after 24 hour in-house duty. ACGME policy states:

.......PGY-1 residents should have 10 hours, and must have eight hours, free of duty between scheduled duty periods.

......Intermediate level residents (completed all goals and objectives of CBY & CA-1 and have progressed to CA-2 year) PGY3-4 should have 10 hours free of duty, and must have eight hours between scheduled duty periods.  They must have at least 14 hours free of duty after 24 hours of in-house duty.

.......Residents in the final years of education must be prepared to enter the unsupervised practice of medicine and care for patients over irregular or extended periods. While it is desirable that residents in their final years (achieved G&O of all core rotations and fulfilled minimum case requirements- usually PGY-4) of education have eight hours free of duty between scheduled duty periods, there may be circumstances (as defined by the Review Committee) when these residents must stay on duty to care for their patients or return to the hospital with fewer than eight hours free of duty.

.......Circumstances of return-to-hospital activities with fewer than eight hours away from the hospital by residents in their final years of education must be monitored by the program director.

 

 

6.      Maximum frequency of in-house night float

.......Residents must not be scheduled for more than six consecutive nights of night float.

 

7.      Maximum In-House On-Call Frequency

.......PGY-2 residents and above must be scheduled for in house call no more frequently than every- third-night (when averaged over a four-week period).

 

At-Home Call

.......Time spent in the hospital by residents on at-home call must count towards the 80-hour maximum weekly hour limit.  The frequency of at-home call is not subject to the every-third night limitation, but must satisfy the requirement for one-day-in-seven free of duty, when averaged over four weeks.

 

.......Residents are permitted to return to the hospital while on at-home call to care for new or established patients.  Each episode of this type of care, while it must be included in the 80-hour weekly maximum, will not initiate a new "off-duty period."

 

8.      Alertness Management/Fatigue Mitigation

…… faculty members and residents are educated to recognize the signs of fatigue and sleep deprivation and residents in alertness management and fatigue mitigation processes (link on GME web page)

…… fatigue mitigation processes to manage the potential negative effects of fatigue on patient care and learning include providing call rooms and encouraging naps as patient care duties allow. Separate in-house OB and OR call teams (with separate in-house faculty) and ICU resident (home call faculty) provide back-up for each other if a team has an unusually busy call night without sufficient breaks to mitigate fatigue A senior resident (SR) is assigned to each OR call to help faculty provide appropriate breaks to mitigate resident fatigue. Separate home call teams (faculty and resident) for Shriner’s Burn Hospital and Cardio-thoracic lessen the in-house call burden and act as a source of back-up call if necessary for resident well-being and patient safety. In the the event that a resident may be unable to perform his/her patient care duties, this resident may be relieved by other residents on call, call faculty or rarely the back-up call team to  ensure continuity of patient care.

…....residents who may be too fatigued to safely return home are provided quiet, secure sleep facilities separate from the OR call rooms.