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Brigham and Women's and Massachusetts General Hospitals Institutional Policy re: Resident Duty Hours

The following provisions apply to all graduate medical education training programs sponsored by the Brigham and Women’s and/or Massachusetts General Hospitals and accredited by the Accreditation Council for Graduate Medical Education (ACGME). Further, they apply to residents in these programs assigned to any other institution or clinical site as part of their GME program.

• Resident duty hours are herein defined as time spent at the worksite performing clinical and/or academic activities required by the resident's GME training program, including:
  • patient care activities, both inpatient and ambulatory, whether scheduled or not (i.e., includes time spent in the hospital when a resident is called in from home)
  • administrative activities that are related to patient care
  • in-hospital “on call”, regardless of what the resident activities are during such periods
  • scheduled academic activities (i.e., conferences and other didactics).

  (Exclusions: beeper call from home and/or academic preparatory work that is or could be done offsite.)

• The Hospital endorses the duty hour and on-call limits defined by the ACGME (paraphrased below in italics), with additional clarifications and extensions as noted:
  • Residents must not be assigned duty hours in excess of 80 hours per week, averaged over a four-week period. Note: Programs that have received approval, first from the Hospi-tal's GME Committee and then from their RRC, may assign up 88 hours of duty per week. Moonlighting hours shall be counted toward the weekly duty hours limit.
  • Residents must be provided with at least one day off in seven, averaged over a four-week period. Note: A day off is defined as a continuous 24-hour period free from assigned educational and clinical responsibilities, including offsite beeper call, rounds and conferences.
  • Residents must not be assigned in-house call any more often than every third night, averaged over a four-week period. Note: This excludes beeper call from home.
  • Residents should have at least 10 hours off between regularly scheduled on-site duty shifts (including after in-house call). Note: This is not meant to preclude short duty periods punctuated by short breaks, such as 6 hours on/2 hours off/6 hours on, which might also be considered as a single 14-hour shift.
  • Residents must not be scheduled to work in excess of 24 consecutive hours. Note: While residents may remain on duty a maximum of six additional hours to participate in didactic and certain clinical activities to maintain continuity of care, residents may not assume the care of new patients after 24 hours of continuous on-site duty, as specified by the individual RRC.
    
    
• In addition to the above, the Hospital further requires that assigned clinical responsibilities (including offsite call) must not preclude adequate rest and reasonable personal time. In this regard, program directors should carefully monitor the frequency of extended shifts, moonlighting activity and instances of urgent or emergent patient care requiring the resident's return to the worksite during periods of call from home.

• Each program is required to have a written duty hours policy consistent with this Institutional Policy. Such policies must also address any additional limits on resident work-hours included in the relevant ACGME (sub)specialty Program Requirements.

• Programs must provide alternative coverage for a resident's clinical responsibilities if the resident is too fatigued to continue his/her assigned clinical responsibilities. Residents must promptly notify a supervising physician if they are concerned that fatigue is impairing their performance. (Unless otherwise specified by the program, residents should notify the supervising physician as outlined in the program’s Resident Supervision Policy for cases of illness arising during a work shift.)

• The program's duty hours policy and resident relief procedures must be communicated to all members of the faculty and resident staff.

• Program directors shall define a schedule for monitoring resident work hours. During periods of monitoring, residents are required to document their workhours accurately and completely. Program directors shall periodically review the data with the goal of ensuring compliance with this and the program's duty hours policies and report their findings and responses to the GME Office and/or the Hospital's Graduate Medical Education Committee upon request.

• Program Directors shall ensure that training regarding the symptoms of fatigue and their effects on performance is provided to faculty and residents.

• Residents should report a pattern of excessive duty hours and/or clinical workload to their program director and/or department chief. If appropriate changes in the program or individual resident's schedules are not implemented on a timely basis, residents should so inform the Hospital's Director or Associate Director of Graduate Medical Education.

Approved by the Partners Education Committee, 3/15/04