Altru Family Medicine Residency

WORK HOUR POLICY

General
The residency program complies with ACGME work hour policies.  Compliance is monitored by the duty hours log maintained in the electronic databse at E-value.net.  This database is reviewed regulary and anomalous entries and discrepancies challenged and explained.  An administrative assistant and designated faculty member have oversight responsibility.  In addition, hard copy of the work hours log is reviewed by all faculty on a monthly basis.

Fatigue and sleep deprivation
There is required attendance at a presentation on fatigue and sleep deprivation by a sleep disorder specialist.  Attendance at the sleep disorder clinic is also part of the required behavioral science rotation.  The resident pool provides sufficient redundancy to allow call substitution and recovery time in the event of a fatigued or indisposed resident.

Transfer of patient supervision
Errors of omission and commission during patient care "handoffs" present a significant threat to patient safety.  Adequate, protected, time is provided for the hand over of care, twice daily, at the change of shifts.  Patient status is updated and outstanding studies and continuing therapies are reviewed, with particular emphasis on the critically ill, unstable, and those needing further evaluation.

Accommodation and subsistence
Residents are provided with food service, a study area with electronic database connectivity, and a private sleeping area, the latter separated from patient care areas.

Work Hour Regulations:

  • First year residents will not work more than 16 hours on single or combined shifts and each 16-hour shift will be followed by a ten-hour break before other assigned duties or responsibilities.
  • Second and third-year residents may work 24-hour shifts and such shifts will be followed by fourteen hours free from assigned duties or responsibilities.
  • All residents must have one 24-hour period free from assigned "in hospital" duties and responsibilities, and be absent from the hospital, every seven days, averaged over a four-week period.
  • No resident will work more than 80 hours per week averaged over a four-week period.
  • At home call will not average more than every third night over a four-week period.
  • Onerous activity resulting from such call will require relief from responsibilities.
  • All of the foregoing is monitored through E-value and the timely entering of data is a resident professional responsibility.
  • Failure to record accurate duty hours through E-value within seven days will result in a verbal and email warning.  An additional day of call will be assigned to the resident for each day that the resident fails to record duty hours beginning at 10 days of deficiency.
  • Certain exceptions to the work hour regulations are recognized for infrequent and extenuating circumstances, such as continuity of care for a severely ill or unstable patient, academic importance of an event, contniuity of care of an obstetrical patient, or humanistic attention to the needs of a patient or family.
  • The decision to violate a work hour regulation is at the sole discretion of the resident.
  • Care of all other patients will be handed over to the appropriate team once the resident is in violation of a work hour regulation.
  • The resident must properly document in E-value the rationale for any work hour violation.
  • The violation will be reviewed by an appointed faculty member, discussed with the resident, and appropriate faculty documentation in E-value will be completed.
  • The resident will also be provided a mandated rest period following the work hour violation, as appropriate for the type of violation