The University of Arizona/UPHK Graduate Medical Education Consortium
Graduate Medical Education Committee

PURPOSE:
The institution is charged with the oversight of the ACGME Resident Duty Hours Policy. It is necessary for all our ACGME accredited programs to achieve compliance and for the GME Office to monitor compliance. It is the responsibility of the program director to establish formal written policies governing resident duty hours and on-call schedules that are based upon educational rationale and patient need including continuity of care. The educational goals of the program must not be compromised by excessive reliance on residents to fulfill institutional service obligations. Program directors must ensure that residents are provided backup support when patient care responsibilities are difficult or prolonged. The following policy outlines the procedures to be used by the GME Office.

POLICY:

1. The GME Office will collect and maintain a file containing all of the individual program policies concerning resident duty hours. Individual programs must be in compliance with the following:
   Duty Hours
   
   
   1. a. 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 relative to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled activities such as conferences. Duty hours do not include reading and preparation time spent away from the duty site.
      
   2. duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities.
      
   3. Residents must be provided with 1 day in 7 free from all educational and clinical responsibilities, averaged over a 4-week period, inclusive of call. One day is defined as 1 continuous 24-hour period free from all clinical, educational, and administrative duties.
      
   4. Adequate time for rest and personal activities must be provided. This should consist of a 10-hour time period provided between all daily duty periods and after in-house call.
      
   5. Adequate time for rest and personal activities must be provided. This should consist of a 10-hour time period provided between all daily duty periods and after in-house call.
   
   On-call Activities
   
   The objective of on-call activities is to provide residents with continuity of patient care experiences throughout a 24-hour period. In-house call is defined as those duty hours beyond the normal work day, when residents are required to be immediately available in the assigned institution.
   
   
   1. In-house call must occur no more frequently then every third night, averaged over a 4-week period.
      
   2. Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Residents may remain on duty for up to 6 additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of medical and surgical care. [as further specified by the RRC]
      
   3. No new patients may be accepted after 24 hours continuous duty. [as further specified by the RRC]
      
   4. At-home call (or pager call) is defined as a call taken from outside the assigned institution.

      1. The frequency of at-home call is not subject to the every-third-night limitation. At-home call, however, must not be so frequent as to preclude rest and reasonable personal time for each resident. Residents taking at-home call must be provided with 1 day in 7 completely free from all educational and clinical responsibilities, average over a 4-week period.

      2. When residents are called into the hospital from home, the hours residents spend in-house are counted toward the 80-hour limit.

      3. 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.

      2. Individual programs will submit biannual reports, by October 1 and March 1 of each academic year, documenting the mechanisms utilized to assess compliance with ACGME Institutional and the relevant RRC duty hour requirements.

      3. The GME Office will request action plans from individual programs that are felt to be not in compliance. The GME Office encourages programs to involve residents in the preparation of these plans. The GME Office will request monthly progress reports at the GMEC concerning program's efforts at compliance.

      4. The GME Office will conduct focus group sessions with the residents participating in various rotations to assess not only compliance with the resident duty hour regulations, but also to assess educational aspects, resident stress and quality of life issues. The aid of the Housestaff Counselor will be enlisted in conducting these focus groups.

      5. The Internal Review of programs will include specific questions concerning resident duty hours during the review of all programs. These reports will be included in the summaries submitted to the GMEC. The GME Office will submit a report to the Dean annually for submission to our governing body, the Arizona Board of Regents.

<< Back