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:
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. Residents should work together to ensure that the 8 hour break rule is followed in a compliant way (see below). The Program is ultimately responsible for ensuring compliance, however resident efforts to ensure complaince via adjusted scheduling is strongly encouraged. For example, if a house officer leaves the hospital at 11pm the team should support the return of this house officer to duty the next day not before 7am.
4. 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.
5. Referral to Employee Health Services may be recommended if a sleep disorder is suspected, with further evaluation by a sleep specialist as needed.
Clarification of the ACGME 10 hour break rule and the 8 hour exception:
The ACGME allows the 10 hour break between assignments to be shortened to 8 hours on rotations in which day admitting teams sign out to a night float team, as is the case on our Medicine ward rotations.
The educational rationale for invoking the 8 hour exception in our training program is that more cases will be seen by residents, and more complete work up of cases will be facilitated as a result. This rationale is accepted by the ACGME.
Stipulations of the 8 hour break rule exception are the following:
1. The break may never be less than 8 hours.
2. The break must allow for adequate time for rest and personal activities between shifts.
3. The break may not be less than 10 hours more than twice in 7 days (for example, every fourth day/long call day would be acceptable).
Program level process to ensure 8 hour break rule compliance:
1. If you anticipate a break rule violation (or any other work hours violation), you should alert your immediate supervisor (intern alerts resident, resident alerts chief resident, and either may alert chief resident or program director directly). The chief medical resident on call may be reached by paging x10026. Suggestions and real-time support for avoiding a break rule violation will be provided.
2. The Program will monitor complaince via interval anonymous house staff polling. Corrective actions will be taken by the Program Leadership and/or discussed directly with the Chairman of Medicine, the GME Director and the President of the Hospital as needed to ensure compliance.