Resident Work Hours

Effective Date: 7/1/99                                                         
Reviewed/Revised:  9/12/05; 10/27/06, 11/17/06; 9/21/07, 3/19/10

Number:  9200-206

The New York Hospital Medical Center of Queens, in compliance with the New York State Department of Health Code, Section 405, and the ACGME duty hour regulations has adopted a policy relating to post-graduate trainee work schedules in Medicine, Surgery, OB/GYN, Pediatrics, Transitional Year, Radiation Oncology, Emergency Medicine, Podiatry and Dental Medicine. These work hour rules also apply to all residents who rotate to NYHQ.

Duty hours are defined as all clinical and academic activities related to the residency program, i.e. patient care (both inpatient and outpatient), administrative duties related to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled academic activities such as conferences.  Duty hours do not include reading and preparation time spent away from the duty site.

The scheduled work week shall not exceed an average of 80 hours per week over a four-week period.

Residents shall not be scheduled to work for more than 24 consecutive hours.

A maximum 3 additional hours for transfer of information about patients is allowed in connection with a consecutive 24-hour shift if (1) the resident 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.

In-house call must occur no more frequently than every third night, averaged over a four-week period.

Scheduled activities which count in the 80-hour work week and for the 24-hour consecutive work rule include inpatient assignments, outpatient clinic and ED assignments, required conferences and other required educational activities, and on-site activity/direct patient care which occurs when a resident is on beeper call.

Scheduled on-duty assignments shall be separated by not less than 10 non-working hours.

All exceptions to the 10 non-working hours' rule must be presented to the GMEC for approval.

Residents shall have at least one 24-hour period of scheduled, non-working time per week.  This means no scheduled activities including beeper call. 

Provisions for Emergency Medicine:

Emergency Medicine rotators and residents should not work more than 60 scheduled hours per week seeing patients in the Emergency Department and no more than 72 total duty hours per week.  Duty hours comprise all clinical duty time and conferences, whether spent within or outside the educational program, including all on-call hours.   

Residents may not work longer than 12 continuous scheduled hours.  There must be at least an equivalent period of continuous time off between scheduled work periods.  Residents may have up to 3 hours to transfer care of patients and conclude care of patients already evaluated.  They may not start care on any new patient during this time. 

Special Provisions for Surgery Residents:

On call duty in the hospital during the night shift hours shall be included in the 80-hour work week 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 are generally resting and that interruptions for patient care are infrequent and limited to patients for whom the resident has continuing responsibility; and

Such duty is scheduled for each resident no more often than every third night; and

A continuous assignment that includes night-shift "on-call" duty is followed by a non-working period of no less than 16 hours; and

The department has written policies and procedures to immediately relieve a resident from a continuing assignment when fatigue due to an unusually active "on-call" period is observed.

Each resident shall notify his/her department of any employment outside of assigned program duties (i.e. moonlighting).  Residents are prohibited from working outside of the training program if the addition of such hours will exceed the 80-hour maximum work week 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 of Graduate Medical Education work hours survey.

Work hours shall be contemporaneously logged by residents into a computerized tracking system. (Contemporaneously shall mean within a two-week period.) Each resident shall receive a user ID and password and instruction on how to use the system.

The Program Directors are responsible for ensuring compliance with this policy.  They, (or their designees) shall review monthly schedules to assure their conformity with work regulations; they shall also review tracking data available in the computerized tracking work hour log for each of the residents in their departments.  The computerized tracking system is programmed to contemporaneously alert all Program Directors and the Director of Graduate Medical Education to possible violations of any work hour rules. The Program Directors shall submit the logs monthly to the Office of Graduate Medical Education for presentation at the GMEC along with any remedial action to maintain work hour regulation compliance.  A quarterly report shall be forwarded to hospital wide CQI.

Radiation Oncology will use the tracking system made available at the NYH.  The program director shall submit a monthly report to the GMEC.

Anthony Somogyi, M.D.

Director of Medical Education
Chairman, Graduate Medical Education Committee

Revised and approved by GMEC on 3/19/2010