Duty Hours and Fatigue Recognition
- It is the policy of the UAMS College of Medicine Department of Surgery that residents (both surgical and visiting) shall not exceed ACGME duty hour requirements. The Department of Surgery shall not make assignments that knowingly violate ACGME duty hour requirements. Residents (both surgical and visiting) have an affirmative duty to assist the Department of Surgery in duty hour monitoring.
- This duty includes an obligation on the part of all residents to promptly report any actual or impending situation where a duty hour limit is in danger of being exceeded. This report must be made to the Surgery Program Director, the Surgery Residency Coordinator or the Surgical Chief Resident. This duty is in addition to any duty hour reporting obligation to any other entity.
- Surgery residents shall submit a weekly report “yellow card” to the residency program coordinator detailing working hours. Chief residents are excused from this requirement, but are still required to adhere to ACGME duty hour standards. Residents on services where duty hour violations are unlikely may also be excused from continuous monitoring by the Program Director. Failure to comply with this requirement may result in dismissal from the Surgery Residency Program, removal of OR privileges or other corrective action.
- Visiting residents shall comply with duty hour monitoring programs conducted by their own department, the UAMS GME committee or other entities. Visiting residents shall comply with all other provisions of this memorandum, including timely required reporting of potential situations where duty hour limits are in danger of being exceeded.
- Faculty members have an affirmative duty to assist with duty hour compliance and monitoring and may contact the Chairman or Program Director regarding any difficulties regarding duty hours.
- The Department of Surgery considers the failure by any resident (surgical or visiting) to report in a timely manner a situation where duty hour limits are in danger of being exceeded to be academic dishonesty. The Department of Surgery also considers the reporting of false duty hour information to be academic dishonesty. Residents who demonstrate academic dishonesty in this matter may be sanctioned.
- Duty hours are defined as all clinical and academic activities related to the residency program; i.e., patient care (both inpatient and outpatient), administrative duties relative to patient care, the provision for transfer of patient care; time spent in-house during call activities, and scheduled required activities such as mandatory conferences. Duty hours do not include reading and preparation time spent away from the duty site.
Residents may voluntarily use the hospital or medical school library or study facilities during their off duty hours, but such time shall not be considered as “duty hours.”
- Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities.
- Residents must be provided with 1 day in 7 free from all educational and clinical responsibilities, averaged over a 4- week period, inclusive of call. One day is defined as 1 continuous 24-hour period free from all clinical, educational, and administrative duties.
- 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.
The objective of on-call activities is to provide residents with continuity of patient care experiences throughout a 24-hour period.
In-house call is defined as those duty hours beyond the normal work day, when residents are required to be immediately available in the assigned institution.
- In-house call must occur no more frequently than every third night, averaged over a 4-week period.
- Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Residents may remain on duty for up to 6 additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of medical and surgical care.
- No new patients may be accepted after 24 hours of continuous duty. A new patient is defined as any patient for whom the surgery service or department has not previously provided care.
At-home call (or pager call) is defined as a call taken from outside the assigned institution.
- The frequency of at-home call is not subject to the every-third- night limitation. At-home call, however, must not be so frequent as to preclude rest and reasonable personal time for each resident.
- Residents taking at-home call shall 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 in-house shall count toward the 80-hour limit.
- The program director and the faculty will monitor the demands of at-home call in their programs, and make scheduling adjustments as necessary to mitigate excessive service demands and/or fatigue. Residents have an affirmative duty to assist in this monitoring of these duty hours by reporting situations where duty assignments are in danger of becoming excessive.
- Residents shall have formal refresher education in fatigue recognition and management annually.
- Faculty shall be provided educational material on fatigue recognition and management for their personal review on a periodic basis.
- Residents have an affirmative duty to report to their program director, supervising attending or any supervisor when they may be too fatigued to effectively or safely care for patients, drive home after call or attend to other tasks.
- All members of the Department of Surgery (Faculty, Residents, Visiting Residents, Staff are expected to contact the program director, chairman or other supervisor if they believe any resident may be too fatigued to effectively or safely care for patients, drive home after call or attend to other tasks.
- The Department of Surgery will make adjustments in duty assignment or take other appropriate action when a report as described above is received.