COTTAGE HEALTH SYSTEM POLICY

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SUBJECT:

SURGICAL RESIDENT DUTY HOURS AND WORKING ENVIRONMENT

 

DEPT: MEDICAL EDUCATION
POLICY #: 8240.10

 

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

 

POLICY

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 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.

 

DEFINITIONS

Duty hours:  all clinical and academic activities related to the program.  This includes patient care, administrative duties relative to patient care (including those, if any, conducted from home), 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 the Santa Barbara Cottage Hospital Surgical Residency Program at a place which is NOT used by the Santa Barbara Cottage Hospital Surgical Residency Program for training.

 

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

 

Scheduled duty periods:  Assigned duty at this hospital or other training site encompassing hours which may be within the normal work day, beyond the normal work day, or a combination of both.

 

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.

     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.

 

2.  Maximum duty period length: 

        a. Duty periods of PGY-1s must not exceed 16 hours in length.

        b. Duty periods of PGY-2 and above residents are limited to 24 hours of continuous duty in the hospital.  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.

        c.  After 16 hours of continuous duty, residents are encouraged to engage in strategic napping, especially when the 16 hour mark occurs between 10:00 pm and 8:00 am, applying these procedures: 

  • Residents are encouraged to retire to the call room for strategic naps as often as is reasonably possible
  • In an effort to reduce interruptions from non-critical pages, each floor will be asked to batch calls to each service pager and hold non-essential calls between 10:00pm and 8:00 am.
  • In an effort to reduce nap interruptions, residents may choose to alternate naps with other on call residents; the non-napping residents may thus carry the napping resident's pager.
  • The on-call attending physician should be notified if a resident becomes overly fatigued and a nap is not possible. In these instances the attending physician may need to answer any floor calls, etc. to make a strategic nap possible for the resident.
  • Residents are to notify the program director should there be any issues with the procedures listed above.

 

3. Individual exceptions to maximum duty hour period:  In unusual circumstances, a resident may remain beyond their scheduled period of duty to continue to provide care to a single patient.  These policies apply:

  • The extension of the duty hour period must be initiated voluntarily by the resident ? never assigned, or suggested, by a faculty member or senior resident.
  • PGY-1s are not permitted to remain beyond their scheduled duty hour period.
  • Possible justifications for this extension of the duty hour period include:  Continuity of care for a severely ill or unstable patient, academic importance of the events transpiring, or humanistic attention to the needs of a patient or family.
  • The resident must transfer the care of all other patients to the resident team responsible for their continuing care.
  • The resident will complete the Duty Hour Extension Form and submit that form to the Program Director by email, mailbox or in person within 24 hours of completion before leaving the hospital at the completion of this extended duty hour period.
  • The Program Director will review each submission of additional service.

4.  Time off between Scheduled Duty Periods:

  • PGY-1 residents should have 10 hours, and must have at least eight hours, free of duty between scheduled duty periods.
  • PGY-2 and PGY-3 should have 10 hours, and must have 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.
  • PGY-4 and PGY-5 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.  Those circumstances may include:
  1. Continuity of care for patients, such as for:
    1. a patient on whom a resident operated/intervened that day who needs return to the operating room (OR);
    2. a patient on whom a resident operated/intervened that day who requires transfer to the Intensive Care Unit (ICU) from a lower level of care;
    3. a patient on whom a resident operated/intervened that day who is in the ICU and is critically unstable;
    4. a patient on whom a resident operated/intervened during that hospital admission, and who needs to return to the OR for a reason related to the procedure previously performed by resident; or, a patient or patient?s family with whom a resident needs to discuss limitation of treatment/DNR/DNI orders for critically-ill patient on whom the resident operated.
  2. A declared emergency or disaster, for which the residents are included in the disaster plan; or, to perform high profile, low frequency procedures necessary for competence in the field. 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. Night float rotations must not exceed two months in duration, and there can be no more than three months of night float per year. There must be at least two months between each night float rotation.

 

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."

 

7. Moonlighting is not allowed at any level for surgical residents.

7/11

 


COTTAGE HEALTH SYSTEM POLICY

RECOMMENDED BY: J. Gauvin, M.D. DATE: 6/11

ORIGINAL POLICY EFFECTIVE DATE: 7/03

APPROVED BY: E. Wroblewski, MD DATE: 6/11

DATE REVISED: 6/11 DATE REVIEWED: