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Medical College of Georgia
Graduate Medical Education Policies and Procedures
Office of Primary Responsibility: Graduate Medical Education
No. HS 10.0
House Officer Duty Hours and Work Environment
1.0 Purpose
To provide an Institutional statement regarding House Officers duty hours
and work environment as mandated by the ACGME and the Joint Commission by the
Accreditation of Health Care Organizations
2.0 Procedure
2.1 Definitions
2.1.1 Duty hours: 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 work site.
2.1.2 In-house call:
those duty hours beyond the normal workday when House Officers are required
to be immediately available in the assigned Institution.
2.1.3 Internal Moonlighting:
Clinical and administrative activities performed within the Residency
Program and/or the sponsoring Institution or the non-hospital sponsor's
primary clinical site(s) which are voluntary and NOT required, and for which
additional compensation is given. This time must be counted toward the
80-hour weekly limit on duty hours.
2.1.4 Home call (pager call):
Call taken from outside the assigned Institution. This call is not subject
to the every third night limitation. If the House Officer is called into the
hospital from home, those duty hours are counted toward the 80-hour limit.
2.1.5 New patient: any
patient for whom the House Officer has not previously provided care.
2.2 Background
Providing House Officers with sound academic and clinical education must be
carefully planned with concerns for patient safety and House Officers well
being. Each Program Director must ensure that the learning objectives of the
Program are not compromised by excessive reliance on House Officers to fulfill
service obligations. Didactic and clinical education must have priority in the
allotment of House Officers time and energies. Duty hour assignments must
recognize that faculty and House Officers collectively have responsibility for
the safety and welfare of patients. The Program Director must establish an
environment that is optimal for House Officers education and for patient care,
while ensuring undue stress and fatigue among House Officers are avoided.
2.3 The educational goals of the
Program and learning objective of House Officers must not be compromised by
excessive reliance on House Officers to fulfill Institutional service
obligation. Duty hours, however, must reflect the fact that responsibilities
for continuing patient care are not automatically discharged at specific times.
Programs must ensure that House Officers are provided appropriate backup support
when patient care responsibilities are especially difficult or prolonged.
2.4 House Officer duty hours and
on-call time periods must not be excessive. The structuring of duty hours and
on-call schedules must focus on the needs of the patient, continuity of care,
and the educational needs of the House Officer. Duty hours must be consistent
with the Institutional and Program requirements that apply to each Program as
outlined by the Accreditation Council for Graduate Medical Education.
2.5 Off Service House Officer call
schedules and duty assignments will be constructed in a manner for the Off
Service House Officer to ensure that there is strict adherence to ACGME
guidelines. The Off Service House Officer MUST report his/her duty hours
to both their primary Program Coordinator and their host Program Coordinator’s
office on a weekly basis. Non-compliance with duty hour requirements MUST
expeditiously be reported to both the primary Training Program Director and to
the host Program Director to permit corrective actions to be taken.
2.6 The Medical College of Georgia
fully supports the Residents Work Hours policy established by the Accreditation
Council for Graduate Medical Education (ACGME), which sets forth in the
following requirements.
2.7 Duty Hours:
2.7.1 A maximum of 80 hours per
week averaged over four weeks, inclusive of all in-house call activities.
2.7.2 Ten hour time period for
rest and personal activities must be provided between all daily duty periods
and after in house call.
2.7.3 House Officers must be
provided with 1 day in 7 free from all educational and clinical
responsibilities, averaged over a four week period, inclusive of call. One
day is defined as on continuous 24 -hour period free from all clinical,
educational and administrative activities.
2.7.4 Twenty-four hours maximum
continuous on-site duty with up to six additional hours permitted for
patient transfer and other activities.
2.7.5 No new patients after 24
hours of continuous duty
2.7.6 House Officers time spent
in the hospital during at-home call to be counted toward the 80-hour maximum
2.7.7 In-house moonlighting to
be counted toward the 80 maximum hours
2.7.8 In-house call must occur
not more than every 3rd night, averaged over 4 weeks.
2.8 At-Home Call (Pager Call):
2.8.1 The frequency of the
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 House Officer.
2.8.2 House Officers taking
at-home call must be provided with one day in 7 completely free from all
educational and clinical activities, averaged over a 4-week period.
2.8.3 When House Officers are
called into the hospital from home, the hours House Officers spend in-house
are counted toward the 80-hour limit.
2.8.4 The Program Director and
the teaching faculty must monitor the demands of at-home call in their
Program and make scheduling adjustments as necessary to mitigate service
demands and/or fatigue.
2.9 Supervision of House Officers
2.9.1 All patient care must be
supervised by qualified faculty. The Program Director must ensure, direct
and document adequate supervision of House Officers at all times. House
Officers must be provided with rapid, reliable systems for communicating
with supervising faculty.
2.9.2 Faculty schedules must be
structured to provide House Officers with continuous supervision and
consultation.
2.9.3 Faculty and House Officers
must be educated to recognize the signs of fatigue and adopt and apply
policies to prevent and counteract the potential negative effects.
2.10 Work Environment:
2.10.1 Food services: House Officers on duty
must have access to adequate and appropriate food services. Food is
provided to House Officers who take-in-house call.
2.10.2 Call rooms: Call rooms are provided for
House Officers who take in-house call.
2.10.3 Support services: Adequate ancillary
support for patient care shall be provided for House Officers at all times.
2.10.4 Laboratory/pathology/radiology services:
these services and the associated information systems must be available and
adequate to support timely and quality patient care.
2.10.5 Medical Records: Medical records system
that document the course of each patient=s
illness and care must be available at all times and must be adequate to
support quality patient care, the education of the House Officer, quality
assurance and provide a resource for scholarly activity.
2.10.6 Security/safety: Appropriate security and
personal safety measures must be provided to House Officers at all training
locations.
2.11 Oversight:
2.11.1 Each ACGME- Accredited
Residency and Fellowship Training Program must establish formal written
policies governing Resident duty hours that are consistent with the
Institutional and Program Requirements. This policy will be communicated to
the House Officer and faculty annually.
2.11.2 The GME Off ice must be provided with a copy of the
policy on a yearly basis. These formal policies will apply to all
participating Institutions where House Officers are trained.
2.11.3 Program directors and
faculty must adopt policies to prevent and counteract effects of fatigue.
Back-up systems must be provided when patient care responsibilities are
unusually difficult or prolonged, or if unexpected circumstances create
resident fatigue sufficient to jeopardize patient care.
2.11.4 Duty hours must be monitored by each Program and a
copy forwarded to the Graduate Medical Education Office who will monitor
duty hours at monthly, quarterly and/or random intervals. Each Program
Director should review each House Officers rotation schedule to assure
compliance with this Institutional policy and the Common Program
Requirements.
2.11.5 Each Program Director
should regularly monitor House Officers duty hours for compliance with this
Institutional policy and the Common Program Requirements. Monitoring of duty
hours is required with frequency sufficient to ensure an appropriate balance
between education and service.
2.11.6 The GMEC shall monitor
compliance with this policy through the:
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Internal Residency Review process for each program
-
Annual GME reports of each program
-
Periodic monitoring of individual programs
2.11.7 Falsification of duty
hour=s data or
pressure to cause the falsification of such data is considered egregious
behavior for House Officers and can result in disciplinary action to include
dismissal. Faculty members are governed by the rules of the Faculty Senate
and policies and procedures of the Medical College of Georgia.
2.11.8 House Officers must
notify their Program Director of requests or pressure to work in excess of
duty hours authorized by this policy.
2.12 Duty Hours Exceptions
2.13 An RRC may grant exceptions for
up to 10 % of the 80-hour limit, to individual Programs based on a sound
educational rationale. The GMEC must review and formally endorse the
exemption prior to submission to the RRC according to the following
procedures:
2.14 The Program Director must
submit a written request for an exemption to the GMEC Chair. The request must
clearly document the following:
2.14.1 Patient Safety:
Information must be submitted that describes how the Program and Institution
will monitor, evaluate, and ensure patient safety with extended House
Officer work hours. This process will include formal reviews with Program
Directors, Program Coordinators, and House Officers through email surveys
and verbal queries.
2.14.2 Educational
Rationale: The request must be based on a sound educational rationale
which should be training for which the increase is requested. Blanket
exceptions for the entire educational program should be considered the
exception, not the rule.
2.14.3 Moonlighting Policy: Specific information
regarding the program's moonlighting policies for the periods in question
must be included.
2.14.4 Call Schedules: Specific information
regarding the House Officers call schedule during the times specified for
the exception must be provided.
2.14.5 Faculty Monitoring: Evidence of faculty
development activities regarding the effects of House Officer fatigue and
sleep deprivation must be appended.
2.15 The Program Director will
present the request in person to the GMEC for discussion.
2.16 If approved by the GMEC, the
Designated Institutional Official (DIO) or the GMEC Chair will provide a
documented written statement of Institutional endorsement of the proposal.
2.17 The Program Director must
submit the request to the RRC according the ACGME=s
RRC Procedures for Granting Duty Hours Exceptions. The paperwork submitted to
the RRC must include a copy of this policy and the current accreditation status
of the program and the status of the sponsoring institution.
Effective Date: 7/05 Revision/Review
Date: 12/05 10/07 |