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Duty Hours Policy

I. Purpose of Policy

The purpose of this policy is to define how the Graduate Medical Education Committee (GMEC), as the Dartmouth-Hitchcock (D-H) governing body for graduate medical education, institutes and supports limits on resident work hours, while assuming responsibility for addressing the impact of compliance with the Accreditation Council for Graduate Medical Education (ACGME) duty hour requirements.

II. Policy Scope

This policy applies to all D-H ACGME-accredited residency and fellowship programs.

III. Definitions

Resident: Any physician in an accredited graduate medical education program, including interns, residents, and fellows.

IV. Policy Statement

Providing residents with a sound academic and clinical education must be carefully planned and balanced with concerns for patient safety and resident well-being. Each 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 have priority in the allotment of residents’ time and energies. Duty hour assignments shall recognize that faculty and residents have collective responsibility for the safety and welfare of patients. The institution shall adhere to the resident duty hour rules as defined by the ACGME.

  1. Duty Hours
    • All residency and fellowship programs shall adhere to the duty hour requirements mandated by the ACGME or their respective Review Committee (RC), including Duty Hour limits defined in the Common Program Requirements:
      • 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.
      • Residents must be scheduled for a minimum of one day free of duty every week (when averaged over four weeks). At-home call cannot be assigned on these free days.
      • Duty periods of PGY-1 residents and above may be scheduled to a maximum of 16 hours in duration.
      • Duty hours of PGY-2 residents and above may be scheduled to a maximum of 24 hours of continuous duty in the hospital.
      • Residents 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.
      • PGY-1 residents should have 10 hours, and must have eight hours, free of duty between scheduled duty periods.
      • Intermediate-level residents [as defined by the RC] 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.
      • Residents in the final years of education [as defined by the RC] must be prepared to enter the unsupervised practice of medicine and care for patients over irregular or extended periods.
      • Resident must not be scheduled for more than six consecutive nights of night float.
      • PGY-2 residents and above must be scheduled for in-house call no more frequently than every-third-night (when averaged over a four-week period).

  2. Each program must comply with any additional clarifications or restrictions defined by their respective RC.

  3. All D-H programs must also comply with the following additions/clarifications:
    • Duty hours must be limited to 80 hours per week averaged over 28 days or the length of the block, whichever is shorter. Duty hours are defined as all clinical and academic activities related to the residency program.

    • Rotations shorter than 28 days must be fully compliant with the 80 hour and 1 day off in 7 rules. Averaging shorter blocks of high intensity and low intensity rotations is not allowed.

    • When vacation is taken during a block, the remainder of the block must be compliant with all duty hour rules.

    • The following must be included when reporting resident duty hours:
      • Patient care (both inpatient and outpatient);
      • Administrative duties related to patient care;
      • The provision for transfer of patient care / sign-outs;
      • Time spent in-house during call activities;
      • Scheduled academic activities such as conferences;
      • Research;
      • Hours spent on activities that are required by the accreditation standards, such as membership on a hospital committee, or that are accepted practice in residency programs, such as residents’ participation in interviewing residency candidates;
      • Any of the above duties, when performed at home or outside the clinical workplace; including EMR note writing and preparation of discharge summaries;
      • Time spent at regional / national conferences / meetings when attendance at the meeting is required by the program, or when the resident is acting as a representative of the program (i.e. presenting a paper or poster). Only actual meeting time counts towards duty hours, travel and non-conference time is excluded.

    • The following should not be included when reporting duty hours: Academic preparation time, such as time spent preparing for presentations or journal club, board review, or other reading and study time.

    • It is not permissible to have the day off regularly or frequently scheduled on a resident’s post-call day, but in smaller programs it may occasionally be necessary to have the day off fall on the post-call day.

    • At-home call (pager call) is defined as call taken from outside the assigned institution. Home call is only appropriate if the service intensity and frequency of being called in is low.
      • The frequency of at-home call is not subject to the every third night limitation. However, at-home call must not be so frequent as to preclude rest and reasonable personal time for each resident. Residents taking at-home call must be provided with 1 day in 7 completely free from all educational and clinical responsibilities, averaged over a 4- week period.
      • When residents are called into the hospital from home, the hours residents spend inhouse are counted toward the 80-hour limit.
      • The program director and the faculty must monitor the demands of at-home call in their programs and make scheduling adjustments as necessary to mitigate excessive service demands and/or fatigue.

  4. Program-Level Policy
    • The D-H GMEC will not accept for review, nor endorse any applications from individual GME training programs seeking exceptions to ACGME duty hour rules and regulations.

    • Each D-H training program, regardless of ACGME-accreditation status, must have written policies and procedures consistent with the Institutional and Program Requirements for resident duty hours.

    • These policies must be readily available to residents and faculty.

D-H Policy ID: 11303