Transcript Resident Duty Hours - UB School of Medicine and Biomedical

Resident Duty
Hours
UB Office of Graduate Medical Education
Donna M. Cummiskey
Director, GME Resource Management
May 20, 2008
Introduction
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UB is committed to promoting patient safety and
resident well-being as well as providing a supportive
educational environment.
Obligation to monitor and enforce duty hour
regulations of both the ACGME and the NYSDOH.
When regs are not in accord, the stricter must be
followed
Hospitals, program directors, attendings, and
residents are collectively responsible for ensuring
patient safety and welfare and compliance with these
regulations
Semi-annual mandatory surveys alert programs to
problems
Resident Training
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Residents and faculty are collectively responsible for
promoting the provision of quality medical care and
adherence to the regulations of our various governing
bodies.
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Prior to beginning training in a UB resident training
program residents must demonstrate knowledge and
understanding of resident duty hour regulations.
Duty Hour Activities
1.
What resident activities are not included in
Duty Hours?
Resident conferences
b. Administrative duties relative to patient care
c. Reading and preparation time spent away from
the duty site
a.
Reading and preparation time spent away
from the duty site
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The ACGME defines Duty hours as:
“…all clinical and academic activities related to the
residency program; i.e., patient care (both inpatient
and outpatient), administrative duties relative to
patient care, the provision for transfer of patient care,
time spent in-house during call activities, and
scheduled activities such as conferences. Duty
hours do not include reading and preparation time
spent away from the duty site.”
Duty Hour Limits
2.
What is the maximum number of hours a UB
resident may work?
80 hours per week
b. 80 hours per week averaged over a 4 week
period, inclusive of in-house call
c. 80 hours per week averaged over a 4 week
period, inclusive of in-house call and beeper call
time spent in-house
a.
80 hours per week averaged over a 4 week
period, inclusive of in-house call and beeper
call time spent in-house
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ACGME: “Duty hours must be limited to 80 hours per
week, averaged over a 4 week period, inclusive of
call.”
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NYS DOH: “The scheduled work week shall not
exceed an average of 80 hours per week over a four
week period.”
Time Off
3.
Residents must be provided with at least one
twenty-four hour period of scheduled nonworking time per week. Which of the
following activities may occur during that
twenty-four hour period?
At-home (pager/beeper) call
b. Brief hospital rounds
c. Non-scheduled or “catch-up” resident activities
d. None of the above
a.
None of the above
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ACGME: “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.”
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NYS DOH: “Post-graduate trainees shall have at
least one twenty-four hour period of scheduled nonworking time per week.”
Continuous Duty
4.
What is the maximum number of hours for
which a resident may remain on duty
following a continuous 24-hour shift
(transition period)?
6 hours
b. 3 hours
c. 0 hours
a.
Three (3) Hours!!
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ACGME: “…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.”
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NYS DOH: “…such trainees shall not be scheduled to
work for more than twenty-four consecutive hours…”
“…an additional unscheduled transition period of up to
three hours may be utilized by facilities to provide for the
appropriate transfer of patient information.”
Transition Period Activities
5.
Which activities may occur during the
unscheduled transition period?
Conduct outpatient clinics
b. Participate in didactic activities
c. Transfer of patient information
d. Accept new patients
a.
Transfer of patient information
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ACGME: “No new patients may be accepted after 24
hours of continuous duty.”
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NYS DOH: “New patient care responsibilities may
not be assigned during the transition period…”
“…an additional unscheduled transition period of up
to three hours may be utilized by facilities to provide
for the appropriate transfer of patient information.”
Moonlighting
6.
Which of the following is true regarding
moonlighting?
Residents may moonlight only with the advance
written permission of the program director
b. Moonlighting must be included part of the 80hour weekly limit on duty hours
c. Moonlighting must comply with all limitations on
resident work hours
d. All of the above
e. None of the above
a.
All of the above
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ACGME: “Moonlighting must not interfere with the ability of
the resident to achieve the goals and objectives of the
educational program. Internal moonlighting must be
considered part of the 80-hour weekly limit on duty hours.”
NYS DOH: “…each trainee [must] notify the hospital of
employment outside the hospital and the hours devoted to
such employment … trainees who have worked the
maximum number of hours permitted … shall be prohibited
from working additional hours as physicians providing
professional patient care services.”
UB GME: “Residents must obtain the advance written
approval of the Program Director, and will be subject to all
applicable limitations on work hours, including those
prescribed by Hospital policy, the NYSDOH, and the
ACGME…”
A Note about On-call Activities
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The frequency of at-home call is not subject to the
every-third-night, or 24 + 6 limitation. However, athome call must not be so frequent as to preclude rest
and reasonable personal time for each resident.
Residents taking at-home call must be provided with
1 day in 7 completely free from all educational and
clinical responsibilities
When residents are called into the hospital from
home, the hours residents spend in-house are
counted toward the 80-hour limit.
In-house call must occur no more frequently than
every third night, averaged over a 4-week period.