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

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

New Duty Hour Standards Amelia Sutton David Ellington Britt Erickson Jamie Nodler Christy Walters Conor Hardeman Gretchen Zsebik Jennifer Durst Caroline Juneau Faculty Advisor: Dr. Goepfert New Duty Hours Standards Major change: All PGY1 shifts


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SLIDE 1

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

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SLIDE 2

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

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SLIDE 3

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

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SLIDE 4

Survey # 1 Results

57%

30/30 responding

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SLIDE 5

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

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SLIDE 6

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)
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SLIDE 7

70% 30%

Survey # 2 Results

23/30 responding

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SLIDE 8

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

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SLIDE 9
  • 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

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SLIDE 10

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

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SLIDE 11
  • 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

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SLIDE 12

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

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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

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SLIDE 14

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