The duty hours restrictions and on-call activities as determined by the ACGME are as follows:
- Duty hours are defined as all clinical and academic activities related to the residency program (patient care, 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.
- Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities.
- 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 activities.
- PGY 1 residents may not work more than 16 consecutive hours in one day.
- PGY 2 – 5 residents may not exceed 24 consecutive hours. Residents may remain on duty for up to 4 additional hours to participate in didactic activities, transfer care of patients, and maintain continuity of medical and surgical care. No new patients may be accepted after 24 hours of continuous duty. Strategic napping after 16 hours between 10pm and 8am is strongly suggested.
- In unusual circumstances, residents, on their own initiative, can provide care to one patient with documentation and monitoring by the program director. Should this occur, an e-mail must be sent to the program coordinator indicating the circumstances the resident is continuing to work, this must include the patients name, date and additional time spent with patient.
- Residents must not be scheduled for more than 6 consecutive nights of night float (the maximum number of consecutive weeks and months per year may.
- Adequate time for rest and personal activities must be provided between all daily duty periods.
- PGY 1 residents must have 10 hours free of duty between scheduled work periods.
- PGY 2- 3 (Intermediate-level residents) must have 10 hours between scheduled duty period. They must have at least 14 hours free of duty after 24 hours of in-house duty.
- PGY 4-5 must be prepared to enter the unsupervised practice of medicine and care for patients over irregular or extended periods. It is desirable that residents in their final years will have 8 hours free of duty between scheduled duty periods, however,there may be circumstances when these residents must stay on duty to care for their patients. If this is the case, please e-mail the program coordinator with patients name, date and extended duration of duty period.
- In-house call must occur no more frequently than every third night, averaged over a 4 week period.
- At-home call (or pager call) is defined as call taken from outside the assigned institution. The frequency is not subject to the every third night limitation. Residents must still be provided with 1 day in 7 completely free of clinical responsibilities, averaged over a 4-week period. When residents are called into the hospital from home, the hours residents spend in-house are counted toward the 80 hour limit.
- The Program Director and the faculty monitor the demands of the at-home call in their programs, and make scheduling adjustments as necessary to mitigate excessive service demands and/or fatigue.
- Residents are to be proactive in monitoring their duty hours. Once call schedules are received, residents should review the schedule and report immediately any potential duty hour violations so that the call schedule can be revised in advance.
- Resident duty hours will be checked weekly for compliance. Should violations occur, the resident be required to complete a Duty Hours Violation Report. These reports will be reviewed and signed off by the Program Director. All violations will be accessed to determine how these violations will be avoided in the future.
- Assessment of the compliance with these requirements will be done through the resident's feedback on the Internet Evaluation Program and through time studies by the residency office.
A report of the previous week's work hours (for purposes of hours reporting, the work week runs Thursday through Wednesday) is due each Thursday in the residency office. Hours are considered delinquent as of Thursday morning, and residents who are delinquent in reporting hours may be suspended from duty. Riverside County Payroll Policy requires all employees to submit a time sheet of hours worked. Hours not recorded in New Innovations may result in a delay of pay. The purpose of reporting hours is for the residency office to monitor work hours and keep them within the ACGME guidelines and to report to the County Payroll Office for compensation.
The residency uses New Innovations to track duty/work hours to verify residents are in compliance with ACGME guidelines as noted above. Residents are required to record work hours on New Innovations on a weekly basis. This includes hours worked at each facility/location. It is extremely important that hours are accurately reported. Under- and over-reporting of hours is not allowed; it is required that all residents accurately report work hours.