Policy Title:
Duty Hours and Time Reporting
Department Responsible:
Graduate Medical Education / Policy Code:
GME / Effective Date:
July 1, 2015 / Next Review/Revision Date: May 2018
Title of Person Responsible:
Designated Institutional Official / Approval Council:
Graduate Medical Education Committee / Date Approved by Council:
May 12, 2015

Policy

It shall be the policy of the Cone Health System that resident duty hours and on-call schedules shall not be excessive and shall be structured to focus on the needs of the patient, continuity of care, and educational needs of the resident physician to comply with the Accreditation Council for Graduate Medical Education (ACGME) duty hour’s standards.

Graduate medical education requires a commitment to continuity of patient care. Patients have a right to expect a healthy, alert, responsible, and responsive physician dedicated to delivering effective and appropriate care. Safe, effective patient care, a good learning environment, and the physician’s well-being require that resident has adequate periods of rest.

Definition

Duty hours: all clinical and academic activities related to the residency program; i.e., patient care (both inpatient and outpatient), administrative duties relative to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled activities such as conferences. Duty hours do not include reading and preparation time spent away from the duty site.

Day off: One (1) continuous 24-hour period free from all clinical, educational, and administrative duties.

Responsibility

A.  The Program Director of each accredited residency program shall be responsible for structuring the duty hours and on-call schedules for the residents assigned to their program. The task of scheduling may be delegated; however the Program Director is ultimately responsible for duty hour compliance.

B.  Residents are responsible for accurately and honestly reporting duty hours, including all time spent moonlighting, per ACGME program requirements.

C.  Concerns regarding duty hours may be reported to the Program Director, the Director of Medical Education, or through the Compliance Hotline at 832-8888 or the Privacy Line at 832-7075.Concerns may be reported anonymously. If concerns are not adequately addressed or one would like additional clarification, residents may contact the Designated Institutional Official (DIO).

ACGME Duty Hour Rules

The following ACGME duty hour rules shall be employed by all Program Directors, unless this conflicts with the requirements of an individual Residency Review Committee.

1.  Residents are limited to a maximum of 80 hours per week, including in-house call and moonlighting, averaged over four weeks. Reading and studying off-site is not included in duty hour calculations.

2.  Residents must be scheduled for a minimum of one day (24 continuous hours) out of seven free from all clinical and educational responsibilities, averaged over four weeks. At home call cannot be assigned on these free days.

3.  Duty periods of PGY-1 residents cannot last for more than 16 hours. PGY-2 Residents and above may be scheduled to a maximum of 24 hours of continuous in-house duty. PGY 2 Residents and above may be allowed to remain on-site for an additional 4 hours to ensure effective transitions in care; however, they must not be assigned additional clinical responsibilities after 24 hours of continuous in-house duty.

4.  PGY-1 Residents should have at least 10 hours and must have 8 hours for rest and personal activities between scheduled duty periods. Intermediate level residents as defined by the Review Committee should have 10 hours free of duty and must have 8 hours between scheduled duty periods. They must have 14 hours free of duty after 24 hours of in-house duty.

5.  Additionally,

a)  Residents cannot be scheduled for in-house call more than once every three nights, averaged over four weeks.

b)  In unusual circumstances and on their own initiative, PGY 2 residents and above may remain beyond their scheduled period of duty to continue 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 events transpiring or humanistic attention to the needs of a patient or family. In this circumstance, the resident must hand over the care of all other patients to the team responsible for their continuing care. In addition, documentation must be provided to the Program Director outlining the reasons for remaining to care for the patient in question. The Program Director must review each submission for additional service and track resident and program-wide episodes of additional duty.

c)  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. Preparation must occur within the context of 80 hours, maximum duty length and one-day off in seven standards. While it is desirable that residents have 8 hours free of duty between scheduled duty periods, there may be circumstances when these residents must stay on duty to care for their patients or return to the hospital with fewer than 8 hours free of duty. These circumstances must be monitored by the Program Director.

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

e)  PGY 2 residents and above must be scheduled for in house call no more frequently than every third night averaged over a 4 week period.

f)  Time spent in the hospital by residents on at-home call must count towards the 80-hour maximum weekly hour limit. At-home call is not subject to the every third night limitation but must not be scheduled on the residents one in seven free day of duty, and should not be so frequent as to preclude rest or personal time for each resident.

g)  Residents are permitted to return to the hospital while on at-home call to care for new or established patients.

h)  In-house moonlighting counts toward the 80 Hour weekly limit. In addition, Program Directors must ensure that external and internal moonlighting does not interfere with the resident’s achievement of the program’s educational goals and objectives.

i)  PGY 1 Residents are not permitted to moonlight.

Time Reporting and Monitoring

Cone Health shall provide a system to electronically monitor duty hours of each resident. Each Program Director shall be responsible for utilizing the system in monitoring the resident’s compliance of the ACGME duty hour standards on a regular basis.

The Office of Medical Education shall monitor compliance on a regular basis.

1)  Duty hours are to be electronically recorded by the resident on a weekly basis.

2)  All duty hours for a given rotation MUST be electronically reported by the 3rd day of the following month.

3)  The Program Coordinator will review duty hours each Friday. Residents not in compliance with the above will be given a reminder to update worked duty hours, with a copy to the resident’s advisor.

4)  If duty hour reporting is not brought into compliance by the end of the rotation the resident will meet with their advisor. Residents will receive a verbal warning and have 24 hours to bring duty hour reporting into compliance with the institutional policy.

5)  A resident’s first incident of non-compliance with duty hour reporting will be addressed by the Program. The Program Director’s response to all duty hour violations (including reporting violations) will be regularly monitored by the Office of Medical Education and reported to the GMEC on a bi-monthly basis.

6)  A second incident of non-compliant reporting of duty hours by the resident will be addressed by the Office of Medical Education. This will require a meeting with the Director of Medical Education and/or the Designated Institutional Official of Cone Health. Recording and monitoring of duty hours on a regular basis is a requirement of the ACGME. Duty hour reporting in a timely fashion is considered part of professionalism, one of the 6 core competencies.

The Program Coordinator will submit to the Office of Medical Education duty hour reports for each month of training. Reports should be sent to the Director of Medical Education by the 6th day of the month on a bi-monthly basis.

Previous Revision/Review Dates

July 2007, Revised

October 2007, Reviewed