COTTAGE HEALTH SYSTEM POLICY

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SUBJECT:

Internal Medicine Resident Duty Hours

 

DEPT: MEDICAL EDUCATION
POLICY #: 8240.10

 

GOAL
To provide a program statement outlining duty hour requirements for the Internal Medicine residency in accordance with ACGME requirements.
      
POLICY

The Internal Medicine Residency Program will schedule resident assignments in compliance with all applicable ACGME requirements. Faculty members know, honor, and assist in implementing the applicable duty hour limitations.  Residents comply with those limitations, accurately report duty hours, and cooperate with duty hour monitoring procedures.  All involved identify and report sources of potential duty hour violations, and collaborate to devise appropriate corrective action. This policy is to be communicated to the residents and faculty annually and applies to all participating sites where residents are trained.  On a quarterly basis, residents must log their duty hours for a 28-day period.  The duty hour report will be submitted to the GMEC for review.

 

DEFINITIONS
Duty Hours:  All clinical and academic activities related to the program.  This includes patient care, administrative duties relative to patient care, provision of transfer of patient care, on-call time spent in-house, and scheduled activities such as conferences.  Duty hours do not include reading and preparation time spent away from the duty site.

External moonlighting:  Voluntary, compensated, medically-related work performed by a resident of Santa Barbara Cottage Hospital Internal Medicine Residency Program at a place which is NOT used by the residency program for training.

Internal moonlighting:  Voluntary, compensated, medically-related work performed by a resident of Santa Barbara Cottage Hospital Internal Medicine Residency Program at this hospital or at any other sites used by the residency program for training.

Scheduled assignments:  Assigned duty at Santa Barbara Cottage Hospital or other training sites.

 

 

PROCEDURE

  1. Weekly limit:  Duty hours are limited to 80 hours per week, averaged over a four-week period,   inclusive of all in-house call activities and all moonlighting (both external and internal).  All moonlighting hours are reported as duty hours.  Note: PGY-1 residents are not permitted to moonlight.
    1. Moonlighting must not interfere with resident education.
    2. Moonlighting is only permitted with prior written approval of the Program Director (see Resident Moonlighting Policy).
  2. Mandatory Days off:  Residents must have one day (24 hour period) every week free of all duty, when averaged over the four weeks of the rotation.
  3. Maximum duty period length: 
    1. Duty periods of PGY-1s must not exceed 16 hours in length.
    2. Duty periods of PGY-2 and above residents are limited to 24 hours of continuous duty in the hospital or other training site.  The resident may remain on-site for transition of care and/or to attend an educational conference when that transition is completed, but may not  perform additional clinical duties (including continuity clinic) during those additional 4 hours.
    3. After 16 hours of continuous duty, residents are encouraged to engage in strategic napping, especially when the 16 hour mark occurs between 10:00pm and 8:00am.  
      Individual exception to maximum duty hour period:  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. Such episodes should be rare, must be of the residents? own initiative, and need not initiate a new "off-duty period" nor require a change in the scheduled "off-duty period."
      1. Under such 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 or returning to care for the patient in question and submit that documentation to the Program Director.
      2. The Program Director must review and track each submission of additional service and track both individual residents' and program-wide episodes of additional duty.
  4. Minimum time off between scheduled duty periods:
    1. PGY-1 residents should have 10 hours, and must have at least eight hours, free of duty between scheduled duty periods.  They must have at least 14 hours free of duty after 24 hours of in-house duty.
    2. PGY-2 and PGY-3 Internal Medicine residents are considered to be in their final years of education and have flexibility in their duty hour assignments, which might be irregular or extended.  It is desirable that these residents have eight hours free of duty between scheduled duty hour periods, but there will be circumstances when they must stay on duty to care for their patients or return to the hospital with fewer than eight hours free of duty.  Such instances of fewer than eight hours away from the hospital must be reported to, and will be monitored by, the Program Director.
  5. In-House Night Float must not be scheduled for more than six consecutive nights.
  6. At-Home Call must satisfy the requirement for one-day-in-seven free of duty.  Time spent in the hospital by a resident on at-home call must be reported in, and count toward, the 80 hour maximum weekly hour limit.  Return to the hospital for episodic care while on at-home call does not initiate a new "off-duty period."
5/12

 


COTTAGE HEALTH SYSTEM POLICY

RECOMMENDED BY: A.Gersoff, M.D. DATE: 4/04

ORIGINAL POLICY EFFECTIVE DATE: 4/04

APPROVED BY: E. Wroblewski,M.D DATE: 5/11

DATE REVISED: 5/11 DATE REVIEWED: 4/09