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