Resident Duty Hours & the Working Environment

DEPT: MEDICAL EDUCATION

POLICY #: 8240.10

GOAL

To provide an Institutional Statement regarding resident clinical experience and education (formerly duty hours and the working environment) in compliance with ACGME requirements. 

POLICY

1. Programs, in partnership with Santa Barbara Cottage Hospital, will design an effective program structure that is configured to provide residents with educational and clinical experience opportunities, as well as reasonable opportunities for rest and personal activities. Each program must be committed to and be responsible for the promotion of patient safety and resident well-being and to providing a supportive educational environment. The learning objectives of the program must not be compromised by excessive reliance on residents to fulfill service obligations. Didactic and clinical education must have priority in the allotment of residents’ time and energy. Duty hour assignments must recognize that faculty and residents collectively have responsibility for the safety and welfare of patients.

2. Each program must develop and implement a written policy regarding resident clinical experience and education and submit this policy to the GMEC for approval. This policy will be communicated to the residents and faculty annually.

a) These policies will apply to all participating institutions where residents are trained.

3. Program Directors and faculty must adopt policies to prevent and counteract effects of fatigue. Back-up systems must be provided when patient care responsibilities are unusually difficult or prolonged, or if unexpected circumstances create resident fatigue sufficient to jeopardize patient care. (See Resident Fatigue Policy)

4. At least quarterly, each program must have residents log their clinical experience hours for a 28-day period and submit a program report the GMEC. The GMEC may, at its discretion or in response to resident request, ask that such surveys be conducted more frequently. The results of each survey will be reviewed by the GMEC at its next regularly scheduled meeting.

5. Each Program Director should regularly monitor resident clinical experience, rotation and call schedules for compliance with this Institutional Policy and the Common Program Requirements.

6. In addition to quarterly clinical experience reports, the GMEC shall monitor compliance with this policy through

a) Special Review Reports/Process

b) Rotation Evaluations completed by residents

c) Random call schedule monitoring by Education Specialist

7) Falsification of clinical experience data or pressure to cause the falsification of such data is considered egregious behavior for residents and can result in disciplinary action to include dismissal.

a) Residents must notify their Program Director of requests or pressure to work in excess of clinical experience hours authorized by this policy.

8) Santa Barbara Cottage Hospital fully supports the Residents Work Hours policy established by the Accreditation Council for Graduate Medical Education (ACGME), which sets forth the following requirements:

a) Maximum Hours of Clinical experience and Educational Work per Week

i) Clinical and educational work hours must be limited to no more than 80 hours per week, averaged over a 4-week period, inclusive of all in-house clinical and educational activities, clinical work done from home, and all moonlighting.

b) Mandatory Time Free of Clinical Work and Education:

i) The program must design an effective program structure that is configured to provide residents with educational opportunities, as well as reasonable opportunities for rest and personal well-being.

ii) Residents should have eight hours off between scheduled clinical work and education periods.

(1) There may be circumstances when residents choose to stay to care for their patients or return to the hospital with fewer than eight hours free of clinical experience and education. This must occur within the context of the 80-hour and the one-day-off-in-seven requirements.

iii) Residents must have at least 14 hours free of clinical work and education after 24 hours of in-house call.

iv) Residents must be scheduled for a minimum of one day in seven free of clinical work and required education (when averaged over four weeks). At-home call cannot be assigned on these free days.

c) Maximum Clinical Work and Education Period Length

i) Clinical and educational work periods for residents must not exceed 24 hours of continuous scheduled clinical assignments.

(1) Up to four hours of additional time may be used for activities related to patient safety, such as providing effective transitions of care, and/or resident education.

(a) Additional patient care responsibilities must not be assigned to a resident during this time.

d) Clinical and Educational Work Hour Exceptions

(1) In rare circumstances, after handing off all other responsibilities, a resident, on their own initiative, may elect to remain or return to the clinical site in the following circumstances:

(a) To continue to provide care to a single severely ill or unstable patient;

(b) Humanistic attention to the needs of a patient or family; or,

(c) To attend unique education events.

(2) These additional hours of care or education will be counted toward the 80-hour weekly limit.

(3) A Review Committee may grant rotation-specific exceptions for up to 10 percent or a maximum or 88 clinical and educational work hours to individual programs based on a sound educational rationale.

(a) In preparing a request for an exception the Program Director must follow the clinical and educational work hour exception policy from the ACGME Manual on Policies and Procedures.

(b) Prior to submitting the request to the Review Committee, the Program Director must obtain approval from the Sponsoring Institution’s GMEC and DIO.

e) In-House Night Float: Night float must occur within the context of the 80-hour and one-day-off-in-seven requirements. [The maximum number of consecutive weeks of night float, and maximum number of months of night float per year may be further specified by the Review Committee.]

f) Maximum In-House On-Call Frequency: Residents must be scheduled for in-house call no more frequently than every-third-night (when averaged over a four-week period).

g) At Home Call

i) Time spent on patient care activities by residents on at-home call must count towards the 80-hour maximum weekly 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 clinical work and education, when averaged over four weeks.

(1) At-home call must not be so frequent or taxing as to preclude rest or reasonable personal time for each resident.

ii) Residents are permitted to return to the hospital while on at-home call to provide direct care for new or established patients. These hours of inpatient patient care must be included in the 80-hour weekly maximum.

COTTAGE HEALTH POLICY

RECOMMENDED BY: E. Wroblewski, M.D. (CMO). DATE: 9/14
ORIGINAL POLICY EFFECTIVE DATE: 5/04
APPROVED BY: E. Wroblewski, M.D. (CMO) DATE: 10/17
DATE REVISED: 5/07, 5/11, 10/17 
DATE REVIEWED: 3/00, 4/01, 9/14