There have been many questions regarding clinical working hours over the past several weeks and when we run the duty hours log, there have been quite a few minor violations, many of which are due to glitches with New Innovations, but some true infractions.
These rules are NOT punitive. If you bring up to the Chiefs, your Attending, the PD, etc. that you are close to violating duty hours, it is NOT a sign of weakness. It is in fact a sign of a mature trainee, respecting the rules, and ensuring you are demonstrating self care and improving your personal wellness!
Ensuring we stay within these duty hour limitations REQUIRES a clear line of communication. We do not know you may be violating working hours UNLESS you communicate that to us. Logging your hours weekly in New Innovations helps with this, but having a converstation about this BEFORE the violation occurs is a better way to proactively prevent them.
I have done my best to summarize the ACGME working hour rules below. This might not encompass all of the rules or address every situation, but it is the ones that have come up most often.
Maximum of 80 hour work week, averaged over a 4 week period.
So yes, there will be weeks in which you work more than 80 hours, but this is often off set by clinic weeks and electives.
MINIMUM of 8 hours off between working shifts
You need this minimum amount of time to allow for the bare minimum amount of time for sleep before beginning your next shift.
Example: If you are on wards and working late, you MUST leave the hospital NLT 2200, given you have to return to the hospital by 0600 for sign out the next day.
There is NO negotiation in this rule, with the only exception being active patient emergency that you are needed for and cannot be handled by the Night team for some reason.
This means, you SHOULD NOT be doing work after 2200, at home or physically at work. You NEED to stop working by 2200.
If you are trying to finish cosigning notes, it is OKAY for you to NOT do this in order to not violate duty hours.
You MUST keep an open line of communication with your Attending, informing them that you have to leave by 2200 (as instructed by the Chiefs, PD, and ACGME). They will understand. You can always revise and cosign notes the next morning while pre-rounding.
Pre-rounding or chart diving at home counts, so if you start doing that task at 0500 for your own preferred work flow, that means you MUST leave by 2100.
MINIMUM of 14 hours off following a 24 hour shift.
MINIMUM of 1 day off per every 7 days, averaged over a 4 week period
1 day is defined as a continuous period of 24 hours
There will be times you might work 12 days in a row, but then will get 2 days off to compensate for this.
MAXIMUM of 24 hours of continuous clinical care PLUS additional 4 hours of time spent for patient safety, completing transitions of care (rounding in the morning on overnight admissions while on CCU counts as transitions of care), or education.
If you have ANY questions about these, please do not hesitate to reach out. Our jobs as your Chiefs is to advocate for YOU!
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