Information on Fatigue, Sleep Deprivation and Duty Hours
The Residency and Departmental Leadership take the subject of duty hour compliance, fatigue and sleep deprivation in trainees very seriously.
The ACGME requires that "Faculty and residents must be educated to recognize the signs of fatigue and sleep deprivation and must adopt and apply policies to prevent and its potential negative effects on patient care and learning."
How we meet the requirement to educate house staff on this topic: (faculty recieve education also)
1. At your institutional orientation, this material was covered.
2. There will be noon conferences during the year on this.
3. You should review this excellent powerpoint topic on the subject by clicking here.
Our policy on fatigue and sleep deprivation is the following:
Our goal is to PREVENT you from working when too fatigued to do so and to PREVENT you from incurring duty hours violations--not just that such occurances are reported and documented!!!
It is also imperative that you appear for duty appropriately rested and fit to provide the services required by your patients. This is your professional responsibility as a physician and as a trainee you must accept a personal role in ensuring this.
1. IF YOU ARE FEELING FATIGUED and are concerned about your ability to function, you should alert your immediate supervisor (intern would alert resident, resident would alert either fellow or chief resident or attending).
2. If you do not feel comfortable alerting those you are working with, you should contact a chief medical resident--either your buddy or the chief on call (10026), or call one of the program directors.
3. House officers who are too fatigued to perform their duties safely will be removed from duty, provided appropriate support and given adequate opportunity to sleep.
4. Referral to Employee Health Services may be recommended if a sleep disorder is suspected, with further evaluation by a sleep specialist as needed.
ACGME BREAK RULE:
The ACGME stipulates that residents should have 10 hours off between assignments and must have 8 hours of between assignments.
1. You leave the hospital at 8:30pm and return at 6:30am the next day = 10 hours break = OK
2. You leave the hospital at 10pm and return at 6:30am the next day = 8 1/2 hours break = OK
3. You leave the hospital at 11pm and return at 6:30am the next day = 7 1/2 hours break = NOT OK
If you anticipate that you will incur a break rule violation and have less than 8 hours off between assignments, you should do the following:
--Alert your immediate supervisor (resident or fellow or attending) and work together to arrange for you to leave earlier in the evening OR come in the next day at a time that allows you an 8 hour break. (30 to 60 minutes later in the morning, for example, as needed.)
--Inform the chief resident on call at 10026--they can help you navigate the situation overall and #1, such that it is more comfortable and achievable for you.
- In unusual circumstances, residents, 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.
- Under those circumstances, the resident must appropriately hand over the care of all other patients to the team responsible for their continuing care; and document the reasons for remaining to care for the patient in question and submit that documentation in every circumstance to the program director.
OTHER ACGME AND IPRO (NY STATE DUTY HOUR RULES)
- Duty hours must be limited to 80 hours per week. NY State does not allow averaging over 4 weeks.
- Residents must be scheduled for a minimum of one day free of duty every week (NY State does not allow averaging over four weeks.) At-home call cannot be assigned on these free days.
- Duty periods of PGY-1 residents must not exceed 16 hours in duration.
- Duty periods of PGY-2 residents and above may be scheduled to a maximum of 24 hours of continuous duty in the hospital.
- 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.
- It is essential for patient safety and resident education that effective transitions in care occur. 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 three hours.(NY State)
- Residents must not be assigned additional clinical responsibilities after 24 hours of continuous in-house duty.
- Intermediate-level residents must have at least 14 hours free of duty after 24 hours of in-house duty
- While it is desirable that residents in their final years of education (PGY 2/3) have eight hours free of duty between scheduled duty periods, there may be circumstances (as defined above) when these residents must stay on duty to care for their patients or return to the hospital with fewer than eight hours free of duty.
- Residents 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). Internal Medicine residency programs must not average in-house call over a four-week period.
- Time spent in the hospital by residents 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.
- At-home call must not be so frequent or taxing as to preclude rest or reasonable personal time for each resident.
- Residents 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”.
- Moonlighting must not interfere with the ability of the resident to achieve the goals and objectives of the educational program.
- Time spent by residents in Internal and External Moonlighting (as defined in the ACGME Glossary of Terms) must be counted towards the 80-hour Maximum Weekly Hour Limit.
- PGY-1 residents are not permitted to moonlight.
- Emergency Medicine shifts may only be 12 hours in length, inclusive of handoff activities (NY State)