Providing residents with a sound academic and clinical education must be carefully planned and balanced with concerns for patient safety and resident well-being. The residency program must ensure that the learning objectives of the program are not compromised by excessive reliance on residents to fulfill service obligations. Didactic and clinical education must have priority in the allotment of residents’ time and energies. Duty hour assignments must recognize that faculty and residents collectively have responsibility for the safety and welfare of patients.
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 activities, such as conferences. Duty hours do not include reading and preparation time spent away from the duty site.
Duty hours are limited to 80-hours per week, averaged over a four-week period, inclusive of all in-house call activities.
Residents are provided with at least one (1) day in seven (7), free from all educational and clinical responsibilities, averaged over a four (4) week period, inclusive of call. One (1) day is defined as one (1) continuous 24-hour period free from all clinical, educational, and administrative activities. Residents should review the service call schedule at the beginning of the block rotation in order to assure they have this required time off scheduled. If this requirement is not met, they are to immediately notify the attending or senior resident so that adjustments in the schedule can be made.
Residents should have at least 10 hours and must have a least 8 hours free of duty between scheduled duty periods. Residents should monitor when they leave the hospital and adjust their return time back to the hospital to meet this requirement. Residents should notify their team (attending or senior resdient) of when they will be returning the next day.
Assessment of the compliance with these requirements is done through New Innovations. Duty hour violations are discussed with each resident and service chief every 4 week block. In order to ensure that residents are not working beyond the duty hour limits, residents are required to log their duty hours on no less than a weekly basis. However, in order to ensure accuracy, residents are encouraged to log their duty hours on a daily basis.
Riverside County Payroll Policy requires all employees to submit a time sheet of hours worked. The duty hours report from New Innovations is used by the program staff to generate resident time sheets. Hours not logged into New Innovations may result in a delay of pay. A report of the previous weeks work hours (for purposes of hour report, the work week runs Thursday – Wednesday) is due each Thursday morning in New Innovations. Hours not logged as of Thursday at 8:00 am are considered delinquent.
In-house call occurs no more frequently than every third night, averaged over a 4 week period.
For PGY-1 residents, continuous on-site duty, including in house call, cannot exceed 16 consecutive hours. For PGY-2 and PGY-3 residents, continuous on-site duty, including in-house call, cannot exceed 24 hours. PGY- 2 and PGY- 3 residents may remain on-site for up to an additional 4 hours in order to facilitate effective transfer of care. PGY-2 and PGY-3 residents must have at least 14 hours free of duty hafter 24 hours of in-house duty.
If a PGY-1 resident notices they are experiencing signs and symptoms of fatique or sleep deprivation, the reisdent must notify their on-call senior resident; the senior resident will then cover for the resident so they can take a strategic nap. If a PGY-2 or PGY-3 resident notices they are experiencing signs and symptoms of fatique or sleep deprivation, the resident must notify their on-call attending physician. If the attending physician is not already on-site, the attending physician will physically come to the hospital to cover for the resident so they can take a strategic nap.
Residents must not be scheduled for more than 6 consecutive night shifts. Residents must be available for obstetrical delivery of their continuity prenatal patients throughout their 3 years of training. Continuity deliveries, and end of life care and other special cintinuity experiences that result in extended duty hours are not considered duty hour violations.