New Duty Hour Standards Amelia Sutton David Ellington Britt Erickson - - PowerPoint PPT Presentation

New Duty Hour Standards

Amelia Sutton Britt Erickson Christy Walters Gretchen Zsebik Caroline Juneau David Ellington Jamie Nodler Conor Hardeman Jennifer Durst

Faculty Advisor: Dr. Goepfert

New Duty Hours Standards

• Major change: All PGY1 shifts are limited to 16

hours

• Minor changes

– PGY1s may not take home call – Previous continuous duty 24+6 rule now limited to 24 hrs + 4 hours for transition of care – Specialty‐specific: no more than 12 weeks of night float per year, must have 8 weeks off between night rotations, and no longer than 8 weeks straight

Proposals for PGY1 16 hour limit

• 6‐night night float for PGY1s

– Advantages

• Allows more full weekends off remainder of year
• Conference only missed for 6 weeks for PGY1 year

– Disadvantages

• Fatigue/Isolation
• 5‐night night float for PGY1s with Friday nights split between

GYN, IUP, Medicine clinic, and Onc clinic PGY1s

– Advantages

• Less fatigue/isolation

– Disadvantages

• Less full weekends off throughout the year
• Less flexibility in vacation schedule
• PGY1s will miss more conferences due to duty hour restrictions
• PGY1s will miss out on other clinical/surgical opportunities if they have to

miss Friday am

Survey # 1 Results

57%

30/30 responding

Survey # 1 Results By Class

• PGY4

– 6‐night night float: 5 – Friday night split: 2

• PGY3

– 6‐night night float: 4 – Friday night split: 3

• PGY2

– 6‐night night float: 4 – Friday night split: 4

• PGY1

– 6‐night night float: 4 – Friday night split: 4

Duration of Consecutive Night Float

• 6 weeks straight

– Advantages

• Switch internal clock once
• Gets it over with
• Team continuity

– Disadvantages

• Prolonged fatigue/isolation
• 6 week block split 3 weeks Night Float + 3 weeks MEU

– Advantages

• Less prolonged fatigue/isolation

– Disadvantages

• Switch internal clock X 2
• Teams switching at multiple times (PGY1s, PGY2/3s, PGY4s)

70% 30%

Survey # 2 Results

23/30 responding

Weekend Call

• Friday

– Night float intern 2100‐0700 – Short call 1600‐2100

• Medicine clinic, Oncology clinic, GYN, MEU
• Saturday

– Day shift 0400 (PP rounds) – 1700 – Night shift 1700 – 0700

• Sunday

– Day shift 0400 (PP rounds) – 1700 – Night float 1700‐0600

• PGY1s may no longer take home call
• Will be split between PGY2s and PGY3s
• Proposed changes

– Report to L&D 1600 Friday to assist in transition (must leave by 1900 to be available for PP rounds) – PP round with PGY1 & 2 Jun‐Dec – PP round with PGY1 & 2 Jan‐Jun if PP list > 20 pts – Help IUP round if IUP list > 15 pts

Home Call

Consecutive Duty Hour Limits

• Previously limited to 24 hours + 6 hours for

transition of care

• Now 24 hours + 4 hours for transition
• Affects IUP rounding the most
• Will pull IUP resident from the call pool
• For the Board PGY4 who rounds on the weekends

– Assistance with home call PGY2 or 3 if needed – Adjusting rounding times with MFM faculty – Example Sat 24 hour call

• IUP rounds starting at 5 am Sat
• Must leave by 9 am Sunday after rounds

– In future, consider taking Board PGY4 out of call pool

• Limitations also affect June transition time and

Holiday schedule

– Ensure residents are at hospital no longer than 28 hours – Utilization of night float system during Holiday schedule across all classes

Consecutive Duty Hour Limits

Effect on Duty Hours PGY1 and PGY2

• PGY1

– Night float 77 hours including transition time – Other rotations mostly decrease in total duty hours – 1‐2 full weekends off per month (ave 1.6)

• PGY2

– Increased home call will increase total hours – Limit to OBCC/REI/GYN (total hours currently average 47‐61 hrs/week with 4‐6 days off/4 weeks) – New schedule increases total duty hours by 12 hrs/4 week period – Will maintain average 4 days/4 weeks off

Effect on Duty Hours PGY3 and PGY4

• PGY3

– Increased home call will increase total hours – Except IUP and Onc, current average duty hours 40‐60 hours/week during year with 4‐6 days off/4 weeks – New schedule: increases total duty hours by 12 hours/4 week period – Will maintain 4 days off/4 weeks

• PGY4

– Minimal effect – Checkout time for L&D moved from 6:30 to 6 so adds 2.5 hours/week to Board PGY4

Other Changes

• 80 hours must include internal and external

moonlighting

– Will be developing guidelines for external moonlighting

• More detailed guidelines for supervision
• Must have 8 hours and should have 10 hours

between shifts

– Will be helpful on Oncology rotation