Newyork-Presbyterian Hospital Graduate Medical Education Policies and Procedures

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TITLE: DUTY HOURS (Effective July 2011)

PURPOSE:

The purpose of this Policy is to support the physical and emotional well-being of the Graduate Staff at New York-Presbyterian Hospital, promote an educational environment, and facilitate patient care. These procedures have been developed to regularly monitor Graduate Staff duty hours for compliance with this Policy and the ACGME Institutional Requirements.

POLICY:

  1. It is the policy of New York-Presbyterian Hospital (NYP) to comply with New York State 405 Regulations and with ACGME policy on duty hours for postgraduate trainees (i.e. residents and fellows). These are the minimum standards on duty hours that programs must follow. Individual programs may choose to follow more restrictive guidelines.
  2. Each Program sponsored by New York-Presbyterian Hospital shall develop and implement appropriate duty hour policies, compliant with the ACGME Common Requirements, NYS DOH policies, as well as each Program’s RRCs requirements. The more restrictive duty hour requirements shall be followed.
  3. The program directors and clinical service chiefs are accountable for ensuring compliance with duty hours policies. The GME Committee, the Medical Board, and the Board of Trustees receive periodic reports on duty hour compliance as part of the QA process.
  4. Each Program must use an approved Web-based duty hour logging system. Graduate Staff are required to log their duty hours quarterly.  Compliance will be reviewed by the GME office and the duty hours subcommittee of the GMEC, followed by the full GMEC.
  5. Policies and procedures must be implemented in all programs to relieve a post-graduate trainee due to fatigue.
  6. Duty hours are defined as all clinical and academic activities related to the educational program: 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.
  7. Duty hours must be limited to 80 hours per week averaged over 4 weeks, inclusive of all in-house activities, clinical assignments, and moonlighting activities. (Please refer to the NYP moonlighting policy for other information about moonlighting.) Note: New York Presbyterian Hospital does not allow programs to apply for the 10% exception to the 80-hour rule.
  8. Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours (24 consecutive hour rule) for PGY2 and above residents/fellows or 16 hours for PGY1 residents. For PGY2 and above residents, ACGME strongly suggests strategic napping, especially after 16 hours of continuous duty and between the hours of 10:00 PM and 8:00 AM. Trainees may remain on duty for up to 3 additional hours of transition time to be used for transfer of patient care, rounds, and grand rounds. No new patient care may be assigned during the 3-hour transition time (total of 27 hours).
    Note: New York Presbyterian Hospital does not allow programs to apply for the 24 consecutive hour exemption.
  9. Per ACGME, in unusual circumstances, residents, on their own initiative, may remain beyond their scheduled period of duty to continue to provide care to a single patient. Justifications for such extensions of duty are limited to reasons of required continuity for a severely ill or unstable patient, academic importance of the events transpiring, or humanistic attention to the needs of patient or family. Under those circumstances, the resident must:
    1. appropriately hand over the care of all other patients to the team responsible for their continuing care and
    2. document the reasons for remaining to care for the patient in question and submit that documentation in every circumstance to the program director, who must review and track each submission of this kind.
  10. Work in the emergency department is limited to 12 consecutive hours followed by a minimum of 12 hours off duty.
  11. Adequate time for rest and personal activities must be provided. This should consist of a 10 hour time period between all daily duty periods, but at a minimum, must be an 8 hour period, and for PGY2 and above, must consist of a 14 hour time period after in-house 24 hour call.
  12. Every trainee must have at least 24 consecutive hours free from all duty, including call from home, each week.
  13. In house call for PGY2 and above residents/fellows can be no more frequent than every 3rd night (when averaged over a four-week period).
  14. Residents/fellows must not be scheduled for more than six consecutive nights of night float.
  15. Call from home is not counted toward the 80-hour limit. If the trainee is called on-site, the hours are counted toward the 80-hour total.

Approved by GMEC: April 2011

Approved by The Medical Board: June 2011

Reviewed by GME Office: September 2014