1. ACGME DUTY HOUR STANDARDS A BRIEF SYNOPSIS February 1 st, 2011

2. Objectives  Review Current Standards  Highlight Upcoming Changes (effective July 2011)  Q&A

3. Current Standards  Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities.  Continuous on-site duty, including in-house call, must not exceed 24(+6) consecutive hours.  A 10-hour break period must be provided between all daily duty periods and after in-house call.  Residents must be provided with 1 day in 7 free from all educational and clinical responsibilities, averaged over a four-week period, inclusive of call (in-house and at-home).

4. 80 Hour Rule – What counts?  All clinical and academic activities related to the residency program including:  clinical care  in-house call  night float and day float  internal moonlighting (N/A at Stanford)  transfer of patient care  administrative activities related to patient care  didactic conferences  hospital committee meetings  interviewing residency candidates  For at-home call, only the hours spent in the hospital after being called in to provide care count.  Duty hours do not include reading, studying, and academic preparation time spent away from the hospital or ambulatory site.  STARTING IN JULY: External moonlighting counts too.

5. 24(+6) Rule  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, but…  No new patients may be accepted after 24 hours of continuous duty.  STARTING IN JULY:  PGY ‐ 1 residents must not exceed 16 consecutive hours, period.  For all others, 24(+4) instead of 24(+6).  Residents must not be assigned additional clinical responsibilities after 24 hours of continuous in ‐ house duty.

6. 10 Hour Break Rule  A 10 hour break must be provided between all daily duty periods and after in-house call.  There are no exceptions to this rule and it is not averaged across 4 weeks.  For consecutive days of in-house call (e.g. over a weekend), a 10 hour break must be provided between duty periods.  For at-home call, any time spent in the hospital after being called in is counted toward the 80 hour limit, however, time spent in the hospital while on at-home call does NOT initiate a new off-duty period.  STARTING IN JULY: Intermediate-level residents must have14 hours free of duty after 24 hours of in-house duty.

7. 1in 7 Rule  One day is defined as one continuous 24-hour period.  Averaged over a four-week period  Having the day off occur immediately following in- house call is okay only if preceded by a 10 hour break (so in total, you would have 10+24 hours off before your next duty period).  At-home call must not be assigned on these free days.  However, because a break period is not required following at-home call, the day after at-home call may be considered 24 hours off.  No changes to this rule in July.

8. Other Rules  In ‐ house call must occur no more frequently than every third night, averaged over a four ‐ week period.  The frequency of at ‐ home call is not subject to the every ‐ third ‐ night, or 24(+6) limitation, but must satisfy the 1 in 7 rule.  STARTING IN JULY:  Residents must not be scheduled for more than six consecutive nights of night float.  PGY ‐ 1 residents are not permitted to moonlight.

9. Averaged over a 4-week period?  Averaging occurs by rotation, either a four-week or a one-month period, or the period of the rotation if it is shorter than four weeks.  Programs must not combine heavy and light assignments (e.g. rotations having in-house call with those that do not) to obtain a lower average.  Vacation time and leave is not included in the calculation.

10. Resources  FAQs:  http://med.stanford.edu/gme/current_residents/dutyh ours.html http://med.stanford.edu/gme/current_residents/dutyh ours.html  New standards coming July 2011:  http://acgme-2010standards.org/ http://acgme-2010standards.org/

11. Questions?