GMEC Duty Hours
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Intent:
The ACGME requires that all programs have policies regarding duty hours for residents.
Policy Statement:
Each program must have written policies and procedures consistent with the Institutional and Program Requirements for resident duty hours and the working environment. These policies must be distributed to the residents and the faculty. Monitoring of duty hours is required with frequency sufficient to ensure an appropriate balance between education and service.
Description:
- Resident duty hours must not be excessive and must be consistent with the Program Requirements of the RRC.
- On-call time and duty hours should be consistent with the educational needs of the resident and not be motivated by excessive reliance on the residents to fulfill institutional service obligations.
- Duty hours are defined as all clinical and academic activities related to the residency program, i.e., patient care (both inpatient and outpatient), administrative duties related to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled academic activities such as conferences. Duty hours do not include reading and preparation time spent away from the duty site.
- Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities.
- 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. One day is defined as one continuous 24-hour period free from all clinical, educational, and administrative activities.
- 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.
- In-house call must occur no more frequently than every third night, averaged over a four-week period.
- Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Residents may remain on duty for up to six additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of medical and surgical care as defined in Specialty and Subspecialty Program Requirements.
- No new patients, as defined in Specialty and Subspecialty Program Requirements, may be accepted after 24 hours of continuous duty.
- At-home call (pager call) is defined as call taken from outside the assigned institution.
- The frequency of at-home call is not subject to the every third night limitation. However, at-home 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, averaged over a 4-week period.
- When residents are called into the hospital from home, the hours residents spend in-house are counted toward the 80-hour limit.
- The program director and the faculty must monitor the demands of at-home call in their programs and make scheduling adjustments as necessary to mitigate excessive service demands and/or fatigue.
- Consistent with Institutional Policy, all outside activity (moonlighting) must comply with all of the duty hours restrictions noted above
- Program specific policies must include:
- Duty hour limits per week
- Days off per week
- On-call schedules
- Maximum hours on call
- Ten-hour rest period
- Outside activity (moonlighting)
- Programs are expected to have valid and reliable methods to demonstrate compliance with the duty hour rules.
- The GMEC will monitor compliance by the programs by the Internal Review policy, periodic resident surveys and interviews and when needed collection of time cards from the residents.
Last Reviewed by: Institutional Committee for Graduate Medical Education June 12, 2003
