Schedule

DUTY HOUR POLICY

ACGME/BELL COMPLIANCE
EFFECTIVE JULY 1, 2011

• Maximum duty hours for all residents will be limited to 80 hours/week averaged over 4 week period .
• The program provides adequate sleeping facilities with privacy for all residents
• There is no request for duty hour exemption from ACGME by the program
• Moonlighting is not allowed in the Department.
• Regular working hours for PGY II residents and above, Monday to Friday are 6:30 a.m. – 6:30 p.m. Working hours for PGY I residents is either 6:30 a.m. - 7:30 p.m. or 6:30 p.m. to 7:30 a.m.
• Ward Rounds start at 6:30 a.m. including weekdays, weekends and holidays
• The transition time for patient sign out and resident education is no longer than 2 hours and post call residents do not have assignment of additional clinical responsibilities
• The program provides either direct or indirect attending supervision of all residents in the duty hour period. The attending will be ultimately responsible for all patients and residents will have guided authority and responsibility depending on their PGY level.
• There is always an attending surgeon in house during the on call period.
• PGY I duty period does not exceed 16 hours in duration
• PGY I residents when on call at night are not on duty for more than 6 consecutive nights, not more than two months in a row and the total number of calls at night does not exceed three months in one year. There is at least two months between each night float rotation.
• PGY II and above duty hour is a maximum of 24 hours of continuous duty in the hospital with strategic napping after 16 hours of continuous duty and/or between 10:00 p.m. and 6:00 a.m. 2-3 hours of napping will be arranged. There are three physician assistants working at night to help facilitate the napping period.
• All PGY I residents after being on call for 16 hours and all PGY II and above residents after scheduled regular working period do have 10 hours and definitely have 8 hours free of duty between scheduled regular working period
• All PGY II and above residents, after 24 hours of call have at least 14 hours free of duty
• Residents get one day (24 hours) free from all clinical and educational responsibilities every week when averaged over 4 weeks with no home calls on their free days
• There are always two interns on call in the night float. When an intern calls in sick the remaining intern covers the call.
• At the PGY II to IV level, when a resident calls in sick there is another resident on call to take the slot. If not the chief resident on call until 8:30 p.m. stays to take the call and goes home the next day.
• If a chief resident calls in sick the senior resident on call with the chief resident takes over.
• Education of faculty and residents to recognize the signs of fatigue and sleep deprivation and how to prevent and manage fatigue to avoid adverse effect on patient care occur regularly. The program director and faculty monitor the residents for effects of sleep deprivation and fatigue
• There will be a Quarterly review by the Institution of the on-call schedule for the department to make sure these requirements are met. The report generated will be reviewed by the Advisory Committee

There are three different schedules for the residents

1. PGY I
2. PGY II to PGY IV
3. PGY V (chief residents)

• Average length of resident work week over 4 week period

PGY I – 76.61 hours
PGY II – PGY IV – 73.75 hours
PGY V (chief resident) – 76.61 hours

• Maximum number of hours worked by residents

PGY I – 13 hours
PGY II – V – 24 hours

• Transition time - 2 hours

• In house call per week over 4 week period

PGY I -
PGY II – V – 2.3

• Average hours off duty between duty shifts

PGY I - 11.00
PGY II – IV – 13.46
PGY V - – 13.05

ON-CALL SCHEDULE FOR PGY II - IV

X = 24 hours free of clinical and educational responsibilities

On Call:            6:30 a.m. –  6:30 a.m.  =  24 hours            9 x 24 = 216            

Regular Day:            6:30 a.m. –  6:30 p.m. =  12 hours       5 x 12 = 60        

                        9:00 a.m. ­­-- 6:30 p.m  =    9.5 hours       2x 9.5  = 19                                           

                                                                                       __________          

Total hours on duty in 28 days                                                  295                        

Average hours on duty per week:      73.75

Total hours in 28 days – 24x28 = 672

Total hours on duty in 28 days – 295

Total hours off duty in 28 days – 672 – 295 = 377

Average hours off duty between duty shifts 377/28 = 13.46

NAP 10:00 P.M. – 1:00 A.M.

NAP 1:00 A.M. – 4:00 A.M.

ON-CALL SCHEDULE FOR CHIEF RESIDENT

X = 24 hours free of clinical and educational responsibilities

On Call:                        6:30 a.m. –    6:30 a.m.  =   24 hours               3 x 24 =  72       

                                    6:30 a.m. –    8:30 p.m.  =   14 hours               6 x 14 =  84                                                                       

Regular Work Day:     6:30 a.m.  -   6:30 p.m.  =  12 hours               11x 12 =132 

                                    9:00 a.m..  -   6:30 p.m.  =  9.5 hours               2x 9.5 = 19                                           

                                                                                                                __________

Total hours on duty in 28                                                                                     307                        

Average hours on duty per week:      76.6

Total hours in 28 days 24 x 28 = 672

Total hours on duty in 28 days = 307

Total hours off duty in 28 days = 672-307 = 365

Average hours off duty between duty shifts – 365/28=13.05

Chief and senior resident:  (not ICU)

Nap 10:00 p.m. – 1:00 a.m.Nap 1:00 a.m. – 4:00 a.m.