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Office of Graduate Medical Education

RESIDENT SUPERVISION, WORK ENVIRONMENT, DUTY HOURS

POLICY ON RESIDENT SUPERVISION

The following GME Committee policy has been approved by the NYS DOH and conforms to New York State Health Code as well as ACGME requirements. A member of the Medical Staff or qualified attending physician faculty must supervise all residents. The program must ensure, direct and document adequate supervision at all times. Residents must be provided with rapid, reliable systems for communicating with supervising faculty. The attending physician must be in the hospital or he/she must be immediately available by telephone and readily available in person (within 20-30 minutes) at all times.

All residents will consult with the attending physician regarding the assessment and treatment of a patient's illness. Treatment plans will be in accordance with the attending physician's recommendations. When attending physicians are immediately available by telephone and readily available in person when needed, the onsite supervision of routine hospital care and procedures in the acute care specialties of Anesthesiology, Family Practice, Medicine, Obstetrics, Pediatrics, Psychiatry and Surgery may be carried out by postgraduate trainees who are in their final year of training, or who have completed at least three years of training in their program.

For non-acute care specialties, onsite supervision of routine hospital care and procedures may be performed by a resident who is not in the final year of training if the department has specifically credentialed that individual resident to work in that capacity and supervise other residents.

The department must maintain written documentation of such credentialing for each resident who assumes such responsibility. Attending physician supervision in surgery must be direct personal supervision of all surgical procedures requiring general anesthesia or an operating room procedure. All supervision must be documented in the resident rotation schedules and by attending physician on-call schedules. Each department will have available at all times such schedules and will provide such to all interested parties.

As required by Section 405.4 (f) (2) through (3), each Chairman shall maintain and implement appropriate written policies and/or procedures for their respective program’s postgraduate trainees to ensure appropriate delineation of privileges and attending supervision (particularly supervision by attending physicians of care provided to surgery patients by residents).

Revisions approved by GMEC 6/16/10

WORK ENVIRONMENT

The GMEC Resident Subcommittee and the Subcommittee on Resident Affairs monitor the residents work environment through site visits of each program in conjunction with Internal Reviews. Each program, through it‘s annual report, submits an evaluation of the on-call rooms, food services, medical records, lab systems, radiological information retrieval system, safety and security of persons and property, phlebotomy services as well as messenger and transporter services at each teaching site. Each participating institution is committed to providing support services appropriate for safe and effective patient care and to minimize resident effort in non-educational activities.

Date: 4/8/10
To: All Residents and Fellows
From: Stephen Wadowski, MD Associate Dean for GME & DIO
Re: Patient Transport, Phlebotomy and IV Services

It is very important that you are aware of the Patient Transport and Phlebotomy Policies at Kings County Hospital Center and Downstate Medical Center. If you are having issues with ancillary support and have been unable to resolve them along nursing channels, at either Kings County Hospital or University Hospital of Brooklyn, you should contact the AOD (Administrator on Duty) for that facility to report the problem. I would like to remind you that if appropriate ancillary support (phlebotomy, IV services, patient transport) are not being provided for at either KCHC or UHB, you should escalate it as per that institution's procedures (by contacting the AOD). In this way, Hospital Administration and Leadership can become aware of the problems and address them based on current information and real patient care events (dates, times/shifts, MR numbers, and locations). With your cooperation, by addressing support services we hope we can improve the clinical environment and have it be more educationally productive.


DUTY HOURS

Work Hour Surveys

Affiliate hospitals and the Office for GME surveys residents about their working hours periodically. Duty hours surveys are reviewed by the GMEC through its subcommittees to assure compliance. The survey is confidential and residents are required to complete the survey accurately. ACGME Resident Surveys are also used to assess compliance with duty hours limitations. Summary information is used by the GME Office, the residency program directors and affiliate hospitals to monitor compliance with the work hours policy, ACGME Duty Hours Limitations and the laws of New York State.

POLICY ON RESIDENT WORK HOURS

The following GME Committee policy has been approved by the New York State Department of Health and conforms to NYSDOH Section 405 regulations and ACGME requirements:
Duty hours are defined as all clinical and academic activities related to the residency programs, patient care, time spent in-house on call, scheduled academic activities on site.
The scheduled duty hours shall not exceed an average of 80 hours per week over a four-week period inclusive of all in-house call activities, clinic assignments and moonlighting activities. Residents/fellows shall not be scheduled to work continuous on-site duty for more than 24 consecutive hours.
A maximum 3 additional hours for transfer of information about patients rounds and conferences is allowed in connection with a consecutive 24-hour shift if 1) the resident/fellow assumes no new patient care responsibilities during this time, and 2) the transition time is included in the 80-hour work week. The 3-hour transition time shall not be scheduled as part of assigned duties. Scheduled activities, which count in the 80-hour workweek and for the 24-hour consecutive work rule, include inpatient assignments, outpatient clinic, required conferences and other required educational activities, and on-site activity/direct patient care that occur when a resident/fellow is on beeper call.
Each program shall maintain records of direct patient care by residents/fellows on beeper call and adjust call schedules if direct patient care during beeper call regularly causes residents/fellows to exceed the 80-hour workweek. Scheduled on-duty assignments shall be separated by not less than 10 non-working hours between all daily duty periods and after in-house call. Residents/fellows shall have at least one 24-hour period of scheduled, non-working time per week. This means no scheduled activities including beeper call.
In-house calls must occur no more frequently than every third night averaged over 4 weeks. In ED settings, duty hours may be for up to 12 hours followed by 12 hours off.

Special Provisions For Surgery Residents/Fellows:
On-call duty in the hospital during the night shift hours shall be included in the 80-hour workweek and the 24-hour consecutive work limit unless all of the following four conditions are met:


- the program can document that during such night shifts residents/fellows are generally
resting and that interruptions for patient care are infrequent and limited to patients for whom the resident/fellow has continuing responsibility;
- such duty is scheduled for each resident/fellow no more often than every third
night;
- a continuous assignment that includes night-shift "on call" duty is followed by a
non-working period of no less than 16 hours;
- the department has written policies and procedures to immediately relieve a
resident/fellow from a continuing assignment when fatigue due to an unusually active
"on call" period is observed.

Each resident/fellow shall notify his/her department of any employment outside of assigned program duties (i.e., moonlighting). Residents/fellows are prohibited from working outside of the training program if the addition of such hours will exceed the 80-hour maximum workweek or the 24-hour consecutive work limit. The hours devoted to moonlighting must be added to the training program work hours and must be reported on the Office for Graduate Medical Education work hours survey, and to the Chairman and Program Director on any departmental work hours surveys. For departments other than Anesthesiology, Family Practice, Medical, Surgical, Obstetrical, Pediatric or other services which have a high volume of acutely ill patients, and where night calls are infrequent and physician rest time is adequate, the department may develop other scheduling arrangements with approval of the GME Committee.
As required by section 405.4(b) (6) (v), of the NYS DOH Hospital Code, each Program Director shall take appropriate action to ensure that trainees who have worked the maximum number of hours permitted are prohibited from working additional hours as physicians providing professional patient care services.

Approved by NYS DOH 6/2/98
Reviewed and re-approved by GMEC 6/16/10