POLICY ON RESIDENT DUTY HOURS and ON-CALL ACTIVITIES




Definitions: 

Duty hours are defined as 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 duty site.

At-home call (pager call) is defined as call taken from outside the assigned institution. At-Home Call may not be scheduled on the resident’s one free day per week (averaged over four weeks).

  • Time spent in the hospital (exclusive of travel time) by residents on at-home call must count towards the 80 hour per week limit.
  • The frequency of at-home call is not subject to the every third night limitation, but must satisfy the requirement for 1 day in 7 free of duty when averaged over a 4-week period.
  • At-home call must not be so frequent or taxing as to preclude rest or reasonable personal time for each resident. The program director and the faculty must monitor the demands of at-home call in their programs and make scheduling adjustments as necessary to mitigate excessive service demands and/or fatigue.
  • Residents are permitted to return to the hospital while on at-home call to care for new or established patients. Each episode of this type of care, while it must be included in the 80-hour weekly maximum, will not initiate a new “off-duty period”.

Night Float is defined as a rotation or educational experience designed to either 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 and are responsible for admitting or cross-covering patients until morning and do not have daytime assignments. Rotation must have an educational focus. Residents must not be scheduled for more than six consecutive nights of night float. Programs must further abide by any program specific requirements.

Policy:

Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities and all moonlighting.

Duty periods for PGY-1 residents must not exceed 16 hours in duration.

Duty periods of PGY-2 residents and above may be scheduled to a maximum of 24 hours of continuous duty in the hospital. Programs must encourage residents to use alertness management strategies in the context of patient care responsibilities. Strategic napping, especially after 16 hours of continuous duty and between the hours of 10:00 p.m. and 8:00 a.m., is strongly suggested.

  • Residents may be allowed to remain on site in order to ensure that effective transitions occur, however this period of time must be no longer than an additional four hours.
  • 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 a patient or family.
    • Under those circumstances, the resident must:
      • appropriately hand over the care of all other patients to the team responsible for their continuing care; and,
      • document the reasons for remaining to care for the patient in question and submit that documentation in every circumstance to the program director.
    • The program director must review each submission of additional service, and track both individual resident and program-wide episodes of additional duty.

Residents must be scheduled for a minimum of one day free of duty every week when averaged over 4-weeks. At home call cannot be assigned on these free days. One day is defined as one continuous 24-hour period free from all clinical, educational, and administrative activities.

Minimum Time Off Between Scheduled Duty Periods:

  • PGY-1 residents should have 10 hours, and must have eight hours, free of duty between scheduled duty periods.
  • Intermediate-level residents [as defined by the Review Committee] should have 10 hours free of duty, and must have eight hours between scheduled duty periods. They must have at least 14 hours free of duty after 24 hours of in-house duty.
  • Residents in the final years of education [as defined by the Review Committee] must be prepared to enter the unsupervised practice of medicine and care for patients over irregular or extended periods.
    • This preparation must occur within the context of the 80- hour, maximum duty period length, and one-day-off-in seven standards. While it is desirable that residents in their final years of education have eight hours free of duty between scheduled duty periods, there may be circumstances [as defined by the Review Committee] when these residents must stay on duty to care for their patients or return to the hospital with fewer than eight hours free of duty.
      • Circumstances of return-to-hospital activities with fewer than eight hours away from the hospital by residents in their final years of education must be monitored by the program director.

PGY-2 residents and above must be scheduled for in-house call no more frequently than every third night, averaged over a four-week period.

PGY-2 residents and above must not be assigned additional clinical responsibilities after 24 hours of continuous duty

Compliance with Reporting of Duty Hours

  • All trainees (residents and fellows) participating in training programs sponsored by Bridgeport Hospital must participate in the Hospital’s program to monitor compliance with the Duty Hours and On Call Activities as stipulated by the ACGME.

8/2016