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Duty Hours

The training program director must establish an environment that is optimal both for house staff education and for patient care, while that ensuring undue stress and fatigue among house staff are avoided. It is the training program director’s responsibility to ensure assignment of appropriate duty hours so that house staff are not required to perform excessively difficult or prolonged duties regularly. As required by the ACGME, the educational goals of the program and learning objectives of house staff must not be compromised by excessive reliance on house staff to fulfill institutional service obligations. However, duty hours must reflect the fact that responsibilities for continuing patient care are not automatically discharged at specific times. The structuring of duty hours and on call schedules must focus on the needs of the patient, continuity of care, and the educational needs of the house staff.

All training programs must have written policies on work hours for house staff, which must meet ACGME Institutional and Residency Review Committee (RRC) requirements for work hours. Different rotations may require different work hours and patterns; however, the following guidelines for work hours and work environment apply:


Work Hours:

  a.   Workweek: Each house staff shall work no more than 80
  hours of assigned clinical duties per week, including in
  house call activities, when averaged over any 4-week
  rotation or assignment. Adequate time for rest and personal
  activities must be provided. This should consist of a
  10-hour time period provided between all daily duty periods
  and after in-house call. Hours worked outside the scope of
  the training program at UPHS facilities (“internal
  moonlighting”) are to be counted toward the 80-hour limit.
  b.   Emergency Room/Night Float Shifts: Emergency room and
  night float shifts shall be limited to approximately 12
  consecutive hours of patient care. Shifts should be
  separated by approximately 10 hours free from clinical
  c.   Days Off: Each house staff shall have one day in seven (7) free from clinical duties and expectations, when averaged over any 4-week rotation or assignment. Vacation time may be included in the calculation of days free from clinical duties. This policy includes being free from taking call at home.
  d.   In-house Call: Each house staff shall be on in-house call no more than a monthly average of every third night. An acceptable alternative may be a night-float system that conforms to the limitations noted above and complies with the workweek and days off provisions.
  e.   When house staff are taking call from home and are called into the hospital, the hours in the hospital shall be counted toward the duty hours average.
  f.   House staff moonlighting shall occur only in compliance with institutional and program policies governing such activities.

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