https://www.health.ny.gov/facilities/hospital/reports/resident_work_hours/regulations_comparison_guide.pdf
NEWYORK-PRESBYTERIAN
HOSPITAL GRADUATE MEDICAL
EDUCATION POLICIES AND
PROCEDURES
TITLE: CLINICAL AND EDUCATIONAL WORK HOURS POLICY
______________________________________________________________________
REFERENCES:
In accordance with Section IV.K of the ACGME Institutional Requirements, the
Sponsoring Institution must maintain a clinical and educational work hours policy that
ensures effective oversight of institutional and program-level compliance with
ACGME clinical and educational work hour requirements. New York-Presbyterian
(the “Sponsoring Institution”) and its graduate medical education program are also
governed by Part 405 of the Regulations of the New York State Department of Health
(the “Part 405 Regulations”).
PURPOSE:
This Clinical and Educational Work Hours Policy is adopted to ensure that each graduate
medical education program sponsored by the Sponsoring Institution (each a “Program”)
provides residents and fellows participating in a Program (collectively “Residents”) with the
necessary and appropriate educational and clinical work hours and experience, as well as
reasonable opportunities for rest and personal activities. Programs and Residents are
responsible for ensuring that work hour limitations or maximums are not exceeded and
for complying with the Part 405 Regulations, ACGME Institutional, Common Program and
Specialty/Subspecialty Requirements and this Policy.
DEFINITIONS:
It is the policy of NYP to comply with NYS 405 Regulations and with ACGME policy on
clinical and educational work hours for post-graduate trainees (i.e., residents and
fellows). These are the minimum standards on clinical and educational work hours
that programs must follow. Individual programs may choose to follow more restrictive
guidelines.
“At-Home Call (pager call)” means call taken from outside NYP or a Program participating
site. Clinical work done while on at-home call, including time spent in the hospital and
work done at home, such as taking calls or entering notes in an electronic health record
(EHR)/charting, counts against the 80-hour-per-week limit but does not restart the clock
for time off between scheduled in-house clinical and educational work periods. The
remaining time, free of clinical work, does not count against the 80-hour-per week limit.
At-home call may not be scheduled on a Resident’s One Day Off.
“In-House Call” means clinical and educational work hours, beyond the scheduled
workday, when Residents are required to be immediately available within an assignedsite, as needed, for clinical responsibilities. In-House Call does not include Night float,
being on call from home, or regularly scheduled overnight duties.
“Moonlighting,” “Moonlight,” means voluntary, compensated, medically-related work,
performed beyond a Resident’s clinical experience and education hours, and in addition
to the work required for successful completion of a Program. Moonlighting may be
“External” (i.e., performed outside the site where the Resident is in training and any of its
related participating sites), or “Internal” (i.e., performed within the site where the Resident
is in training or at any of its related participating sites).
“Night float” means a rotation or other structured educational experience designed either
to eliminate In-House Call or to assist other Residents during the night. Residents
assigned to night float are assigned on-site duty during evening/night shifts, are
responsible for admitting or cross-covering patients until morning, and do not have
daytime assignments. Such a rotation must have an educational focus.
“One Day Off” means one continuous 24-hour period free from all administrative, clinical,
and educational activities.
“Transitions of Care,” “Transitions,” and all forms of these words, as used in this Policy,
means the relaying of complete and accurate patient information between individuals or
teams in transferring responsibility for patient care in the health care setting.
“Work Hours” or “Clinical and Educational Work Hours” means all clinical and
academic activities related to the Program, i.e., patient care (inpatient and
outpatient), administrative duties relative to patient care, the provision for
transfer of patient care, time spent on in-house call, time spent on clinical work
done at home, and other scheduled academic activities, such as conferences,
grand rounds, didactic sessions or other educational activities. Work
Hours/Clinical and Educational Work Hours do not include reading, studying,
research done from home, and preparation for future cases.
POLICY:
All Programs are required to have policies specifically addressing Resident Clinical and
Educational Work Hours. Programs shall comply with, and all Program policies shall be
consistent with, this Policy, Part 405 Regulations, and with the ACGME Common and
Specialty/Subspecialty Requirements.
Programs and Residents must adhere to the following Work Hour standards and
limitations, except that Programs and Residents participating in Programs with more
restrictive limitations or standards as promulgated by the Program’s associated ACGME
Review Committee (e.g., emergency medicine) shall adhere to such limitations and
standards:
1. Maximum Hours of Clinical and Educational Work Hours per Week. Resident
Work Hours shall not exceed 80 hours per week, averaged over a four-week
period, inclusive of all in-house clinical and educational activities, clinical
assignments, clinical work done from home, and all Moonlighting activities.2. One Day Off in Seven. Residents must have at least One Day Off in seven days,
and in compliance with Part 405 Regulations, this should not be averaged over a
4-week period. Residents cannot be scheduled for At-Home Call during this free
period.
3. 4. 5. 6. 7. 8. Program Exceptions. NYP does not allow Programs to apply for a rotation-
specific exception to the Work Hour limitations pursuant to the Part 405
Regulations.
Maximum Clinical Work and Education Period Length. Continuous on-site
clinical and educational work, including In-House Call, must not be scheduled
to exceed 24 consecutive hours. Residents may remain on duty for up to 3
additional hours of transition time (total of 27 hours) to be used to transition or
transfer patient care, rounds and/or grand rounds. Additional patient care
responsibilities cannot be assigned during the 3-hour transition time period.
This 24-hour, and up to an additional 3-hour period, must occur and be
counted in the 80-hour weekly limit. NYP does not allow Programs or
Residents to access or rely on the surgical exemption available under the
Part 405 Regulations.
Moonlighting. Moonlighting must not interfere with the ability of the Resident to
achieve the goals and objectives of the educational Program and must not interfere
with the Resident’s fitness nor compromise patient safety. As such, Moonlighting is
restricted and must be approved and conducted in accordance with the NYP
Graduate Medical Education Policy and Procedure on Moonlighting.
Maximum “High Intensity” Shift. A Resident’s work in the Emergency
Department is limited to a maximum of 12 consecutive hours followed by at
least an equal period of continuous time off. A Resident must not be scheduled
to work more than 60 hours per week in the Emergency Department and may
not work more than 72 total hours per week.
Mandatory Time Free of Clinical Work and Education. Programs are required
to provide adequate time for rest and personal well-being. Residents shall
have at least 8 hours off between scheduled clinical work and educational
periods. After 24 hours of In-House Call, there must be at least a 14-hour
rest period free of clinical work and educational activities for the Resident.
Maximum In-House Call Frequency. In-House Call for Residents can be
no more frequent than every third night (when averaged over a four-week
period).9. 10. 11. 12. 13. 14. Night Float. Night Float must occur within the context of the maximum Work
Hours per week, mandatory One Day Off in seven, and mandatory time off
between work periods. The maximum number of consecutive weeks of Night
Float and maximum number of months of Night Float per year may be further
specified by each Program’s associated ACGME Review Committee. If a
Program’s ACGME Review Committee has made these further specifications,
the Program must adhere to the ACGME Review Committee limitations.
At-Home Call. Time spent on patient care activities by Residents while on At-
Home Call shall count toward the 80-hour maximum weekly limit. The frequency
of At-Home Call is not subject to the every-third night limitation, but must satisfy
the One Day Off in seven requirement that must be free of clinical work and
education. At-Home Call cannot be so frequently or taxing as to preclude rest
or reasonable personal time for each Resident. Time spent on patient care
activities when on At-Home Call, as well as the time spent by Residents
returning to the hospital to provide direct care for new or established patients
must be counted towards the 80-hour maximum weekly limit. At-Home Call may
not be scheduled on the day that satisfies the One Day Off in seven.
Rotation Outside Home Department. Programs receiving Residents from other
departments and institutions are responsible for assuring that scheduling does
not result in work hour violations. Receiving programs are responsible for
providing the proposed call schedule to the Sending Program for review and
approval in advance of the rotation start date.
Fatigue Mitigation. Programs are responsible for adherence to the GME Fatigue
Mitigation Policy.
Work Hours Monitoring. Residents are responsible for logging Work Hours timely
and accurately. Program Directors are responsible for overseeing Resident Work
Hours, compliance with Clinical and Educational Work Hour policies and ensuring
that Residents do not exceed Work Hour maximums or limitations. The NYP
Graduate Medical Education Committee (“GMEC”) will receive periodic reports on
Clinical and Educational Work Hour compliance to support oversight and timely
address of areas of non-compliance in partnership with the Sponsoring Institution.
Each Program must use an approved Web-based system to log Clinical and
Educational Work Hours, and Residents are required to log their Work Hours every
two weeks. All Residents are required to demonstrate integrity and accountability
when logging their Clinical and Educational Work Hours. Compliance with Work
Hour requirements will be reviewed by the GME Office and the GMEC.
Reporting. NYP is committed to providing effective oversight of Resident Work
Hours and encourages reports concerning Work Hour violations. Any individual
(Resident or faculty) aware of a Work Hours violation should report these
concerns, including complaints, to his/her Program Director, Department Chair or
by emailing the GME Office. Anonymous reports can also be made through the
GME Office or the Office of Corporate Compliance.
APPROVAL DATES:
Reviewed by GME Office: September 2014, July 2017, May 2018, August 2019, October
2024Approved by GMEC: April 2011, September 2017, September 2020, September 2021,
July 2022, November 2024
Approved by The Medical Board: June 2011, December 2020, September 2021, October
2022, December 2024
ASSOCIATED NYP GRADUATE MEDICAL EDUCATION POLICIES AND
PROCEDURES:
NYP Graduate Medical Education Policies and Procedures Moonlighting.