GME Policy Manual
POLICY#: III. 2
SECTION: WORK SCHEDULES
SUBJECT: DUTY SCHEDULES
I. PURPOSE
To provide housestaff officers with a policy on the scheduling of housestaff hours.
II. SCOPE
This policy is directed to all housestaff.
III. DEFINITION
Housestaff - refers to all interns, residents and subspecialty residents (fellows) enrolled in a University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School postgraduate training program. A member of the housestaff may be referred to as a house officer.
IV. RESPONSIBILITY/REQUIREMENTS
Approved by GMEC on 2/23/99A. The Program Director is responsible for duty schedules and, of necessity, must make the ultimate decisions regarding night duty scheduling.
B. On-call rooms are provided by the hospital for residents with on-call responsibility.
C. The on-call schedule will be tailored to meet the residency requirements set by the Accreditation Council on Graduate Medical Education for each training program. It is recognized by the sponsoring institution that in-house call is an integral part of the housestaff education and is to be scheduled so as to maximally enhance that educational pursuit.
D. Duty Hoursa. Duty hours are defined as all clinical and academic activities related to the residency program, ie, 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.
b. Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities.
c. 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 one continuous 24-hour period free from all clinical, educational, and administrative activities.
d. 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.E. 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.a. In-house call must occur no more frequently than every third night, averaged over a four-week period.
b. Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Residents may remain on duty for up to six additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of medical and surgical care as defined in Specialty and Subspecialty Program Requirements.
c. No new patients, as defined in Specialty and Subspecialty Program Requirements, may be accepted after 24 hours of continuous duty. d. At-home call (pager call) is defined as call taken from outside the assigned institution.1). The frequency of at-home call is not subject to the every third night limitation. However, at-home call 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, averaged 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.F. The GME Office receives individual departmental rotation schedules to review for compliance and to formulate monthly housestaff billings. Additionally, the GMEC as part of the review process, reviews individual Program hourly work and on-call schedules for compliance. Scheduled call that is not in compliance with this policy will be returned by the GME Office to the program director to be revised.
G. Oversighta. Each program must have written policies and procedures consistent with the Institutional and Program Requirements for resident duty hours and the working environment. These policies must be distributed to the residents and the faculty. Monitoring of duty hours is required with frequency sufficient to ensure an appropriate balance between education and service.
b. Back-up support systems must be provided when patient care responsibilities are unusually difficult or prolonged, or if unexpected circumstances create resident fatigue sufficient to jeopardize patient care.
H. Duty Hours Exception
An RRC may grant exceptions for up to 10% of the 80-hour limit, to individual programs based on a sound educational rationale. However, prior permission of the institution's GMEC is required. See Policy # III.3 for specific procedures.
Amended on 5/13/03