Transcript ACGME Duty Hour Standards

ACGME DUTY HOUR STANDARDS
A BRIEF SYNOPSIS
February 1st, 2011
Objectives
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Review Current Standards
Highlight Upcoming Changes (effective July 2011)
Q&A
Current Standards
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Duty hours must be limited to 80 hours per week,
averaged over a four-week period, inclusive of all
in-house call activities.
Continuous on-site duty, including in-house call, must
not exceed 24(+6) consecutive hours.
A 10-hour break period must be provided between
all daily duty periods and after in-house call.
Residents must be provided with 1 day in 7 free
from all educational and clinical responsibilities,
averaged over a four-week period, inclusive of call
(in-house and at-home).
80 Hour Rule – What counts?
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All clinical and academic activities related to the residency program
including:
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clinical care
in-house call
night float and day float
internal moonlighting (N/A at Stanford)
transfer of patient care
administrative activities related to patient care
didactic conferences
hospital committee meetings
interviewing residency candidates
For at-home call, only the hours spent in the hospital after being
called in to provide care count.
Duty hours do not include reading, studying, and academic
preparation time spent away from the hospital or ambulatory site.
STARTING IN JULY: External moonlighting counts too.
24(+6) Rule
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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, but…
No new patients may be accepted after 24 hours of
continuous duty.
STARTING IN JULY:
PGY‐1 residents must not exceed 16 consecutive hours,
period.
 For all others, 24(+4) instead of 24(+6).
 Residents must not be assigned additional clinical
responsibilities after 24 hours of continuous in‐house duty.
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10 Hour Break Rule
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A 10 hour break must be provided between all daily
duty periods and after in-house call.
There are no exceptions to this rule and it is not
averaged across 4 weeks.
For consecutive days of in-house call (e.g. over a
weekend), a 10 hour break must be provided between
duty periods.
For at-home call, any time spent in the hospital after
being called in is counted toward the 80 hour limit,
however, time spent in the hospital while on at-home call
does NOT initiate a new off-duty period.
STARTING IN JULY: Intermediate-level residents must
have14 hours free of duty after 24 hours of in-house
duty.
1in 7 Rule
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One day is defined as one continuous 24-hour period.
Averaged over a four-week period
Having the day off occur immediately following inhouse call is okay only if preceded by a 10 hour break
(so in total, you would have 10+24 hours off before
your next duty period).
At-home call must not be assigned on these free days.
However, because a break period is not required
following at-home call, the day after at-home call may
be considered 24 hours off.
No changes to this rule in July.
Other Rules
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In‐house call must occur no more frequently than
every third night, averaged over a four‐week
period.
The frequency of at‐home call is not subject to the
every‐third‐night, or 24(+6) limitation, but must
satisfy the 1 in 7 rule.
STARTING IN JULY:
 Residents
must not be scheduled for more than six
consecutive nights of night float.
 PGY‐1 residents are not permitted to moonlight.
Averaged over a 4-week period?
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Averaging occurs by rotation, either a four-week or
a one-month period, or the period of the rotation if
it is shorter than four weeks.
Programs must not combine heavy and light
assignments (e.g. rotations having in-house call with
those that do not) to obtain a lower average.
Vacation time and leave is not included in the
calculation.
Resources
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FAQs:
 http://med.stanford.edu/gme/current_residents/dutyh
ours.html
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New standards coming July 2011:
 http://acgme-2010standards.org/
Questions?