ACGME DUTY HOUR STANDARDS A BRIEF SYNOPSIS February 1st, 2011 Objectives Review Current Standards Highlight Upcoming Changes (effective July 2011) Q&A Current Standards 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? All clinical and academic activities related to the residency program including: 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 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. 10 Hour Break Rule 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 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 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? 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 FAQs: http://med.stanford.edu/gme/current_residents/dutyh ours.html New standards coming July 2011: http://acgme-2010standards.org/ Questions?