RESIDENT DUTY HOURS AND THE WORKING ENVIRONMENT

GOAL:
To provide an Institutional Statement regarding resident duty hours and the working environment in compliance with ACGME requirements.

POLICY:
Each program must be committed to and be responsible for promoting 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.

PROCEDURE:
Each program must develop and implement a written policy regarding resident duty hours and the working environment and submit this policy to the GMEC for approval. This policy will be communicated to the residents and faculty annually.

These policies will apply to all participating Institutions where residents are trained.

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)

At least quarterly, each program must have residents log their duty hours for a 28-day period and submit a program report to 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 scheduled meeting.

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

In addition to quarterly duty hour reports, the GMEC shall monitor compliance with this policy through:
a) Internal Review Reports/Process
b) Rotation Evaluations completed by residents
c) Random call schedule monitoring by Education Specialist
d) ACGME Resident Duty Hour Survey

Falsification of duty hours 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.

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

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:

1. Duty hours must be limited to 80 hours per week, averaged over a 4-week period, inclusive of all in-house call activities.
2. Residents must be provided with 1 day in 7 free from all educational and clinical responsibilities, averaged over a 4-week period, inclusive of call.
3. Adequate time for rest and personal activities must be provided. This should consist of a 10-hour time period provided between all daily duty periods and after in-house call.
4. In-house call must occur no more frequently than every third night, averaged over a 4-week period.
5. Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Residents may remain on duty for up to 6 additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of medical and surgical care.
6. No new patients may be accepted after 24 hours of continuous duty.
7. If taking at-home call, the hours residents spend in-house are counted toward the 80-hour limit.
8. If residents are engaged in internal moonlighting the hours must be considered part of the 80-hour weekly limit on duty hours. (See Resident Moonlighting Policy)

Duty Hours Exceptions
An RRC may grant exceptions for up to 10% or a maximum of 88 hours to individual programs based on a sound educational rationale. The GMEC must review and formally endorse the exemption prior to submission to the RRC according to the following procedures:

In preparing a request for an exception the Program Director must follow the duty hour exception policy from the ACGME Manual on Policies and Procedures. The Program Director must submit a written request for an exemption to the GMEC which includes:

• Patient Safety: Information must be submitted that describes how the program and institution will monitor, evaluate, and ensure patient safety with extended resident work hours.
• Educational rationale: The request must be based on a sound educational rationale which should be described in relation to the program's stated goals and objectives for the particular assignments, rotations, and level(s) of training for which the increase is requested. Blanket exceptions for the entire educational program should be considered the exception, not the rule.
• Moonlighting Policy: Specific information regarding the program's moonlighting policies for the periods in question must be included.
• Call Schedules: Specific information regarding the resident call schedules during the times specified for the exception must be provided.
• Faculty monitoring: Evidence of faculty development activities regarding the effects of resident fatigue and sleep deprivation must be appended.
• Alternatives explored and rejected in favor of the request;
• Ramifications of rejecting the request;
• That program's latest duty hour survey.

The GMEC will review exemption requests described in #1 above with the program director in attendance; then discuss the request in the absence of the program director but with the participation of the resident member of the GMEC from the program.

If the GMEC endorses the request, a letter of support from the Designated Institutional Official will be generated to accompany the request to the RRC. If the GMEC does not endorse the request, it may not be submitted to the RRC.

The Program Director must submit the request to the RRC according to the ACGME's RRC Procedures for Granting Duty Hour Exceptions. The paperwork submitted to the RRC must include a copy of this policy and the current accreditation status of the program and the status of the sponsoring institution.