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 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)

Survey # 2 Results 30% 70% 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

Home Call • 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

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

Consecutive Duty Hour Limits • 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

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