New Duty Hour Regulations

Transcription

1 New Duty Hour Regulations Faculty Mentor: Dr. Alice Goepfert Chiefs: David Ellington and Amelia Sutton PGY3s: Jamie Nodler and Britt Erickson PGY2s: Conor Hardeman, Christy Walters, and Gretchen Zsebik PGY1s: Jennifer Durst and Caroline Juneau The Challenge The ACGME has issued new duty hour regulations that primarily impact the PGY1 schedule. The major change is that the duty period must not exceed 16 hours for PGY1 residents. Other changes include: 1. PGY1 residents may not take home call. 2. Following 24 hours of continuous duty, no more than 4 hours may be spent in transition of care. This will impact IUP rounds the most. Proposal for compliance with new intern duty hours We propose extending night float for PGY1 residents to 6 days per week. Weekends will be covered by three shifts: two 14 hour day shifts (to allow for post partum rounding) and one 14 hour night shift. This system allows for more entire weekends off for the PGY1 residents. We have developed a proposal for these changes as detailed below. These guidelines are a framework for complying with the new duty hours and will be further refined as we develop the new schedule.

2 Major changes: 1. Labor and Delivery checkout times will be adjusted as following: a. Mon Friday 0600 in the morning b. Mon Thurs 1730 in evening c. Friday 1630 in the evening 2. The night float intern will work Sunday Thursday (except Wednesday until 0700 for lecture), and Friday This will be a total of 78 hours per week. This gives a cushion time of 2 hours during the week. It will be important for the upper levels to ensure that the night float intern leaves at/before board checkout in the mornings. We propose that MFM lectures are moved to 0630 am to allow the PGY1 on night float to attend. 3. The short call/home call system will be adjusted as follows: a. Monday: GYN PGY2 b. Tuesday: REI PGY2 c. Wednesday: Res/US PGY3 d. Thursday: OBCC PGY2 e. Friday: This will be split between the Medicine Clinic PGY1 and Oncology clinic PGY1. As the Oncology clinic resident comes in at 0730, they will be able to stay Friday until 2330 if needed. The PGY1s on GYN and MEU can also take short calls Friday night during vacations/etc. f. Home Call will be divided between the PGY2 and PGY3 classes, as PGY1s may no longer take home call. g. Home call starts 1630 Friday until 1730 Sunday since the Oncology PGY1 must go home at 2330 Friday night.

3 h. As previously, PGY2s and PGY3s will be expected to help post partum round Saturday and Sunday through December. They will stay at the discretion of the chief resident. 4. For Saturday, one intern will be designated the Saturday day call which will be from with addition of post partum rounds (at most 0400 to 1800). They will sign out to a Saturday night call intern at 1730 whose shift will be from For Sunday, one intern will be on call Sunday day in addition to post partum rounds with the PGY 2. Here are examples of potential duty hours for each rotation: 1. NF PGY1: schedule as above = 78 hours + cushion for checkout. This person will need to be excused from conference on Fridays each week during this rotation. 2. Board PGY1: (1700 Fri) for 5 days per week = 69 hours per week. a. no call 69 hours; 2 days off per week b. Day weekend call both days 97 hours, no days off per week (this would be limited) c. Night weekend call 83 hours, no days off per week d. Day weekend call just one day 83 hours, 1 day off per week e. Heaviest schedule over 4 weeks: off two weekends, one day weekend (Sat & Sun), one night weekend average 79.5 hours, 4 days off per 4 week block (worst case scenario). f. Typical schedule over 4 weeks: off two full weekends, one full night weekend call, one just one day weekend call (Sat or Sun) average 76 hours, 5 days off per 4 week block

4 3. Oncology Clinic PGY1: for 4 days per week + Friday short call 4 5 weekends of 6 week rotation = 47.5/54 hours per week (see below). a. No call 47.5 hours; 2 days off per week b. Just Fri short call 54 hours; 2 days off per week c. Fri short call/night weekend call 68 hours, no days off per week d. Fri short call/sun day call 68 hours, one day off per week e. Day weekend call both days 75.5 hours, no days off per week f. Heaviest and typical schedule over 4 weeks: off no full weekends, one just Friday short, one Friday short/night weekend, one Friday short/sun day call, one day call both days 66.4 hours average, 4 days off per 4 week block 4. IUP PGY1: /1700 Friday = 69 hour per week (worst case scenario). For worst case scenario hours, see Board PGY1 hours. Likely, this intern will have less hours, with typical schedule 0500 to 1800/1700 Friday = 64 hours per week. a. No call 64 hours; 2 days off per week. b. Day call both days 92 hours, no days off per week c. Night weekend call 78 hours, no days off per week d. One day weekend call 78 hours, 1 day off per week e. Heaviest schedule over 4 weeks: off two weekends, one day weekend (Sat & Sun), one night weekend 74.5 hours, 4 days off per 4 week schedule. f. Typical schedule over 4 weeks: Off one full weekend, on one night weekend call, one day weekend call, one day weekend call 74.5 hours average; 4 days off per 4 week block. 5. MEU PGY1: /1700 Friday = 59 hours per week. This intern s hours would be closer to those of the Board PGY1 when he/she must assist with post partum rounding during vacations. This resident would also be available to take some Friday short calls if the need arises, but must leave by 2200.

5 a. No call 59 hours; 2 days off per week b. Day weekend call both days 87 hours, no days off per week c. Night weekend call 73 hours, no days off per week d. One day weekend call 73 hours, one day off per week e. Heaviest schedule over 4 weeks off one weekend, one day weekend (Sat & Sun), one short Fri/Sun day call, one just day call = hours average, 4 days off f. Typical schedule over 4 weeks: off one weekend, one day weekend, one night weekend, one short Fri/Sun day call = 71 hours, 4 days off 6. GYN PGY1: /1630 Friday = 56.5 hours. This resident would also be available to take some Friday short calls if the need arises, but must leave by a. No call 56.5 hours; 2 days off per week b. Day weekend call both days 84.5 hours, no days off per week c. Night weekend call 70.5 hours, no days off per week d. One day weekend call 70.5 hours, 1 day off per week e. Heaviest/typical schedule over 4 weeks off one full weekend, one day weekend, one short Fri/Sun day call, one just day call = 68.5 hours, 4 days off. 7. Medicine PGY1: This intern will follow the hours of the Internal Medicine schedule. We look forward to what changes their department proposes. When the resident is assigned to Medicine Clinics, he/she will be responsible for Friday night short calls as above. 8. UAB Oncology: Out of call pool Future Work

6 We propose to utilize the October duty hours as a template to determine how these changes will impact the PGY2 4 classes.