Duty Hours

Family Medicine Reno Residents

All Family Medicine residents must adhere to duty hours rules and regulations in accordance with the ACGME common and Family Medicine Program requirements, as well as the School of Medicine regulations and requirements as published in the School of Medicine GMEC Handbook. The responsibility to adhere to these duty hours requirements lies with the program, attending faculty physicians, and the residents.

Physicians are expected to have a keen sense of personal responsibility for patient care that is not automatically discharged at any given hour or day. In no instance should the resident go off duty until the proper care and welfare of their patients has been ensured.

Please see the Duty/On-Call Hours section of the School of Medicine Resident Physician, and Fellow Handbook of Policies and Procedures, as well as the "Common Program Requirements, Effective July 2011" from the ACGME for the complete document regarding resident working hours. The residency program will periodically require that residents submit information to the program office regarding work hours and days off to monitor and ensure compliance.

  1. Duty hours for Family Medicine Residents will be tracked quarterly using the New Innovations online duty hours tracking system.
    1. All resident duty hours, as defined in the School of Medicine GMEC handbook, must be accounted for in the system
    2. Any internal moonlighting activities must be accounted for
  2. Any resident that is mistakenly scheduled to violate duty hours must immediately bring the issue to the attention of the Program Director and the rotation supervisor by the resident.
    1. Special care and attention should be paid to schedules between rotations (i.e. The end of one rotation and the beginning of the next)
  3. Any resident that is asked to violate duty hours by a rotation supervisor or senior resident must report the event to the program director at the soonest possible opportunity.

Our policies on limiting resident working hours and on resident supervision are meant to help assure that all patients receive high quality care and that residents receive excellent training. All residents, as well as your faculty, residency director and department chair, are responsible for ensuring that these guidelines are followed.

Specific rules (from the ACGME) are as follows:

  1. ACGME and School of Medicine requirements with regard to resident work hours mandate that residents' weekly work hours may not exceed 80 hours when averaged over a 4-week period.
  2. Residents must also have 1 day (i.e. 24 hours) out of 7 off duty when averaged over a 4-week period.
  3. Duty periods for PGY-1 residents must not exceed 16 hours in duration
  4. Duty periods for PGY-2 residents and above may be scheduled for a maximum of 24 hours of continuous duty in the hospital. Residents must not be assigned additional clinical responsibilities after 24 hours of continuous in-house duty
  5. Residents should use alertness management strategies in the context of patient care responsibilities.
  6. Strategic napping, especially after 16 hours of continuous duty and between the hours of 10:00pm and 8:00am is strongly encouraged.
  7. To ensure effective transitions in patient care, residents may be allowed to remain on-site for up to four additional hours.
  8. 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. These "unusual circumstances" are limited to need for continuity of care of a severely ill or unstable patients, academic importance of the events transpiring, or humanistic attention to the needs of a patient or family.
    1. During these circumstances, care of all other patients must be handed over to another physician, and appropriate documentation of the reasons for remaining to care for the patient in question must be submitted to the program director. This documentation must occur each time this occurs. This data will be tracked by the program director.
  9. Residents should have at least 10 hours and MUST have eight hours free of duty between scheduled work periods.
  10. Residents may not work more than 12 continuous hours in an emergency room setting.
  11. All residents must have the opportunity to spend at least one day per week free of clinical, educational and administrative duties when averaged over a 4 week period. A day is defined as a continuous 24-hour block of time, not as a calendar day.
  12. Attending physicians are expected to provide backup if needed so that patient care is not delayed or compromised due to adherence with the above rules.
  13. Since residents rotate on services other than family medicine. If a violation is reported to the program director or chief resident or documented in the New Innovations system. The following steps are taken to understand the violation.
    1. The program director discusses the violation with the affected resident
    2. The program director discusses the violation with the director of the involved rotation
    3. An action plan is put into place to address the violation and prevent if from happening again
    4. The program director monitors this situation carefully - more frequently than the routine quarterly duty hour tracking done through New Innovations.
    5. If a second violation occurs on a service then resident participation on that service is further addressed

Rev. 6/5/14