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 directors 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:
|| Workweek: Each house staff
shall work no more than 80
hours of assigned clinical duties per week, including
house call activities, when averaged over
rotation or assignment. Adequate time for
rest and personal
activities must be provided. This should consist
10-hour time period provided between all daily
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.
|| Emergency Room/Night Float
Shifts: Emergency room and
night float shifts shall be limited to approximately
consecutive hours of patient care. Shifts should
separated by approximately 10 hours free from
||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.
||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.
||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.
||House staff moonlighting shall occur
only in compliance with institutional and program policies
governing such activities.