Surgical Resident Duty Hours & Working Environment
DEPT: MEDICAL EDUCATION
POLICY #: 8240.10.3
To provide a Statement regarding resident clinical experience and education (formerly duty hours and the working environment) in compliance with ACGME requirements.
1. The Santa Barbara Cottage Hospital Surgical Residency Program schedules resident assignments to be in compliance with all applicable ACGME requirements. Faculty members know, honor, and assist in implementing the applicable clinical experience and education expectations. Residents comply with those expectations, accurately report duty hours, and cooperate with clinical experience and education monitoring procedures. All involved identify and report sources of potential work hour violations, and collaborate to devise appropriate corrective action.
2. Maximum Hours of Clinical and Educational Work per Week: Clinical and educational work hours are limited to no more than 80 hours per week, averaged over a 4-week period, inclusive of all in-house clinical and educational activities and clinical work done from home.
3. Mandatory Time Free of Clinical Work and Education:
a) 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.
b) Residents should have eight hours off between scheduled clinical work and education periods.
i) 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.
c) Residents must have at least 14 hours free of clinical work and education after 24 hours of in-house call.
d) 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.
4. Maximum Clinical Work and Education Period Length
a) 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.
5. 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 educational events.
(2) These additional hours of care or education will be counted toward the 80-hour weekly limit.
6. Moonlighting is not allowed at any level for surgical residents.
7. In-House Night Float: Night float must occur within the context of the 80-hour and one-day-off-in-seven requirements.
a) Night float rotations must not exceed two months in duration, four months of night float per PGY level, and 15 months for the entire program.
8) 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).
9) At Home Call
a) 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: J. Gauvin, M.D. (PD) DATE: 11/14
ORIGINAL POLICY EFFECTIVE DATE: 7/03
APPROVED BY: GMEC/E. Wroblewski, MD (CMO) DATE: 1/18
DATE REVISED: 1/18
DATE REVIEWED: 6/11, 11/14