Resident Duty Hours UB Office of Graduate Medical Education Donna M. Cummiskey Director, GME Resource Management May 20, 2008

Introduction 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 Residents and faculty are collectively responsible for promoting the provision of quality medical care and adherence to the regulations of our various governing bodies. 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? a. Resident conferences b. Administrative duties relative to patient care c. Reading and preparation time spent away from the duty site

Reading and preparation time spent away from the duty site 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? a. 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

80 hours per week averaged over a 4 week period, inclusive of in-house call and beeper call time spent in-house ACGME: “Duty hours must be limited to 80 hours per week, averaged over a 4 week period, inclusive of call.” 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 non- working time per week. Which of the following activities may occur during that twenty-four hour period? a. At-home (pager/beeper) call b. Brief hospital rounds c. Non-scheduled or “catch-up” resident activities d. None of the above

None of the above 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.” NYS DOH: “Post-graduate trainees shall have at least one twenty-four hour period of scheduled non- working 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)? a. 6 hours b. 3 hours c. 0 hours

Three (3) Hours!! 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.” 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? a. Conduct outpatient clinics b. Participate in didactic activities c. Transfer of patient information d. Accept new patients

Transfer of patient information ACGME: “No new patients may be accepted after 24 hours of continuous duty.” 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? a. Residents may moonlight only with the advance written permission of the program director b. Moonlighting must be included part of the 80- hour 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

All of the above 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 The frequency of at-home call is not subject to the every-third-night, or 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 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.