7/15/2011 5/16/2014. Effective Date: Reissue Date: NYU School of Medicine. Issuing Department: Graduate Medical Education

Transcription

1 Duty Hour Policy for House Staff Officers Page: 1 of 9 I. Summary of Policy New York State has longstanding regulations restricting Resident Duty Hours. Effective July 1, 2003, the Accreditation Council for ( ACGME ) adopted similar Duty Hour limitations. All GME Training Programs at NYU are expected to meet all duty hour regulations for House Staff Officers as put forth by the ACGME, New York State Title 10 Section 405.4, and any other oversight bodies and report the findings to the Committee and the Hospital Medical Board. In its policy requirements, the ACGME states: 1 Programs and sponsoring institutions must educate residents and faculty members concerning the professional responsibilities of physicians to appear for duty appropriately rested and fit to provide the services required by their patients. The program must be committed to and responsible for promoting patient safety and resident well-being in a supportive educational environment. The program director must ensure that residents are integrated and actively participate in interdisciplinary clinical quality improvement and patient safety programs. The learning objectives of the program must: be accomplished through an appropriate blend of supervised patient care responsibilities, clinical teaching, and didactic educational events; and, not be compromised by excessive reliance on residents to fulfill non-physician service obligations. 1

2 Duty Hour Policy for House Staff Officers Page: 2 of 9 The program director and institution must ensure a culture of professionalism that supports patient safety and personal responsibility. Residents and faculty members must demonstrate an understanding and acceptance of their personal role in the following: a. assurance of the safety and welfare of patients entrusted to their care; b. provision of patient- and family-centered care; c. assurance of their fitness for duty; d. management of their time before, during, and after clinical assignments; e. recognition of impairment, including illness and fatigue, in themselves and in their peers; f. attention to lifelong learning; g. the monitoring of their patient care performance improvement indicators; and, h. honest and accurate reporting of duty hours, patient outcomes, and clinical experience data. All residents and faculty members must demonstrate responsiveness to patient needs that supersedes self-interest. Physicians must recognize that under certain circumstances, the best interests of the patient may be served by transitioning that patient s care to another qualified and rested provider. In this document, all references to House Staff Officers are limited to trainees in ACGMEaccredited specialty and sub-specialty programs. II. Applicability of the Policy This policy applies to House Staff Officers enrolled in all NYU Hospitals Center specialty and sub-specialty training programs.

3 Duty Hour Policy for House Staff Officers Page: 3 of 9 III. Definitions (if applicable) A. ACGME Accreditation Council for B. Call a) At-Home Call (or pager call) is call taken from outside the assigned institution; b) In-House Call is comprised of Duty Hours beyond the normal workday, when House Staff Officers are required to be immediately available in the assigned institution. C. Program Director Director of Residency or Fellowship Training D. Duty Hours Include all clinical and academic activities of the Resident; i.e., patient care (both inpatient and outpatient), administrative duties related to patient care, transfer of patient care, time spent in-house on-call, scheduled academic activities such as conferences, and any moonlighting activities. Duty Hours do not include reading and preparation time spent away from the duty site. E. NYULMC New York University School of Medicine and Hospitals Center F. Residents or House Staff Officers All trainees enrolled in NYU Hospitals Center ACGME-accredited specialty and sub-specialty training programs that involve clinical duties. G. Fatigue Management Recognition by either a resident or supervisor of a level of resident fatigue that may adversely affect patient safety and enactment of a solution to mitigate the fatigue. H. Strategic napping Short sleep periods, taken as a component of fatigue management, which can mitigate the adverse effects of sleep loss. I. External Moonlighting Voluntary, compensated, medically-related work performed outside the institution where the resident is in training or at any of its related participating sites.

4 Duty Hour Policy for House Staff Officers Page: 4 of 9 IV. Policy A. Monitoring and Reporting Procedures - Duty hours must be entered into New Innovations for a minimum of four weeks, twice over the course of an academic year (April and October). All programs must track duty hours during these required tracking times. Programs can individually require more tracking be completed within their program in addition to these set periods of time. 1. Each resident is responsible for direct entry of honest and accurate reporting of their own duty hour information into the New Innovations (NI) system. 2. New Innovations will allow programs the option to establish an automated announcement to be sent to all residents who have not completed their duty hour calendar for the specified period of time. 3. A global set of duty hour types are available to all programs to ensure reported data is consistent across programs. 4. Programs should appropriately remediate any residents or fellows who do not enter Duty Hours into New Innovations 5. Program Directors are responsible for reviewing all duty hour violations reported during the two required monitoring periods. The Program Director will sign-off on all violations where this option is available. 6. The Program Director should review all violations, and make adjustments to program schedules or processes when recurrent violations are noted. 7. Consecutive reporting periods will generate a required Performance Improvement Plan to correct the deficiency to be submitted to the DIO and reported to the GMEC by the Program Director. 8. The GME Office utilizes a standard report from New Innovations to track data relating to both reporting compliance and duty hour violatins and report to the GMEC, and the GMEC will report to the Hospital Medical Boards for the two required monitoring periods.

5 Duty Hour Policy for House Staff Officers Page: 5 of 9 B. Regulations - New York Codes, Rules and Regulations (NYCRR), Title 10, Section 405.4, and ACGME Final Requirements, Resident Duty Hours Language, promulgate Duty Hour restrictions in order that the working conditions and hours of House Staff Officers promote the provision of quality medical care. The regulations establish the following limits on Resident Duty Hours: C. Maximum Hours of Work per Week Duty hours must be limited to 80 hours per week, averaged over a four week period, inclusive of all in-house call activities and all moonlighting D. Duty Hour Exceptions Although a Review Committee may grant exceptions for up to 10% or a maximum of 88 hours, the GMEC has determined they cannot approve any requests since they would be in conflict with the NYS Duty Hour Regulations. i. Moonlighting 1. Moonlighting must not interfere with the ability of the resident to achieve the goals and objectives of the educational program. 2. Time spent by House Staff Officers in Internal and External Moonlighting must be counted towards the 80-hour Maximum Weekly Hour Limit. 3. PGY-1 House Staff Officers are not permitted to moonlight. ii. iii. Mandatory Time Free of Duty House Staff Officers must be scheduled for a minimum of one day free of duty every week (when averaged over two weeks). Athome call cannot be assigned on these free days. House Staff Officers may only work a total of 12 consecutive days. Maximum Duty Period Length 1. Duty periods of PGY-1 House Staff Officers must not exceed 16 hours in duration. 2. Duty periods of PGY-2 House Staff Officers and above may be scheduled to a maximum of 24 hours of continuous duty in the hospital. Programs must encourage House Staff Officers to use alertness management strategies in

6 Duty Hour Policy for House Staff Officers Page: 6 of 9 the context of patient care responsibilities. Strategic napping, especially after 16 hours of continuous duty and between the hours of 10:00 p.m. and 8:00 a.m., is strongly suggested. a. It is essential for patient safety and House Staff Officers education effective transitions in care occur. House Staff Officers may be allowed to remain on-site in order to accomplish these tasks; however, this period of time must be no longer than an additional four hours. b. House Staff Officers must not be assigned additional clinical responsibilities after 24 hours of continuous in-house duty. c. In unusual circumstances, House Staff Officers, on their own initiative, may remain beyond their scheduled period of duty to continue to provide care to a single patient. Justifications for such extensions of duty are limited to reasons of required continuity for a severely ill or unstable patient, academic importance of the events transpiring, or humanistic attention to the needs of a patient or family i. Under those circumstances, the House Staff Officer must: a. Appropriately hand over the care of all other patients to the team responsible for their continuing care; and, b. Document the reasons for remaining to care for the patient in question and submit that documentation in every circumstance to the program director. iv. Minimum Time Off between Scheduled Duty Periods 1. PGY-1 House Staff Officers should have 10 hours, and must have eight hours, free of duty between scheduled duty periods.

7 Duty Hour Policy for House Staff Officers Page: 7 of 9 2. Intermediate-level House Staff Officers [as defined by the Review Committee] should have 10 hours free of duty, and must have eight hours between scheduled duty periods. They must have at least 14 hours free of duty after 24 hours of in-house duty. 3. House Staff Officers in the final years of education [as defined by the Review Committee] must be prepared to enter the unsupervised practice of medicine and care for patients over irregular or extended periods. a. This preparation must occur within the context of the 80 hour, maximum duty period length, and one-day-off-in-seven standards. While it is desirable that House Staff Officers in their final years of education have eight hours free of duty between scheduled duty periods, there may be circumstances [as defined by the Review Committee] when these House Staff Officers must stay on duty to care for their patients or return to the hospital with fewer than eight hours free of duty. v. Maximum Frequency of In-House Night Float 1. House Staff Officers must not be scheduled for more than six consecutive nights of night float. 2. [The maximum number of consecutive weeks of night float, and maximum number of months of night float per year may be further specified by the Review Committee.] vi. Maximum In-House On-Call Frequency 1. PGY-2 House Staff Officers and above must be scheduled for in-hours call no more frequently than every-third-night (when averaged over a four-week period). vii. At-Home Call

8 Duty Hour Policy for House Staff Officers Page: 8 of 9 1. Time spent in the hospital by House Staff Officers on at-home call must count towards the 80-hour maximum weekly hour limit. The frequency of at-home call is not subject to the every-third-night limitation, but must satisfy the requirement for one-day-in-seven free of duty, when averaged over four weeks. i. At-home call must not be so frequent or taxing as to preclude rest or reasonable personal time for each resident. 2. House Staff Officers are permitted to return to the hospital while on at-home call to care for new or established patients. Each episode of this type of care, while it must be included in the 80-hour weekly maximum, will not initiate a new off-duty period. V. Policy Enforcement A. Violation of Duty Hour Limitations - Noncompliance with NYCRR, Title 10, Section 405.4, and/or ACGME requirements for Duty Hours in the Learning and Working Environment is a breach of policy that could jeopardize the accreditation status of the Resident s program and subject NYU to considerable financial penalties. B. Disciplinary Action - Refer to the NYU GME Corrective Action and Disciplinary Policy for House Staff for relevant disciplinary action policy and procedure for compliance. VI. Related Policies (if applicable) A. Corrective Action and Disciplinary Policy for House Staff B. Alertness Management/Fatigue Mitigation VII. Legal Authority/References (if applicable)

9 Duty Hour Policy for House Staff Officers Page: 9 of 9 A. NYCRR, Title 10, Section B. ACGME Requirements for Duty Hours in the Learning and Working Environment Reviewed: Reaffirmed: Supersedes: 10/27/2003 Originally Adopted: 6/10/2003 Approved by: Committee