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Duty Hours

Duty Hours Policy and Procedures

JMH/UM Cardiology Fellowship Programs

 

 

The Jackson Memorial Hospital/University of Miami Miller School of Medicine Graduate Medical Education (GME) office has instituted changes to the institutional Duty Hour policies, as of July 1, 2011.

Per ACGME guidelines, fellows are limited to no more than 80 hours of duty per week, must have at least one day in 7 free from duty, including beeper call.  Further, the fellows must spend less than 30 continuous hours in house when on-call, and have at least 10 hours rest period in between shifts.  Moonlighting is counted toward the 80 work week limit.

Please note the below highlighted changes, effective July 1, 2012:

 

·         Daily duty hour log is mandatory, including moonlighting hours inside/outside of our institutions.

o   Duty log reports will be run on a weekly basis by the GME office for the week prior, with a minimum requirement of 95% fellow compliance. Coordinators will receive these reports and review any deficiencies with the Program Director. Duty hour exception reports will be run by the GME office on a monthly basis. This report will be reviewed by the Chief Fellow and the Program Director.  New Innovation Report of incomplete daily duty hour logs by fellows is forwarded to the program director on a weekly basis by the GME office.

 

·         The cutoff date for residents and fellows to log in their weekly Duty Hours is every Friday

o   Using the new graphical approach created by New Innovations, trainees will click on the duty type, drag the mouse to highlight/select the hours on the graph to record his duty shifts / days off.

o   It is required that the training location be identified for each duty hour entry (no default provided).

 

·         Trainees must account for all days. Including days off, as well as vacation / leave days.

o   Days off (as well as vacation and leave days) are to be designated as “Did Not Work” Days

§  To log days off, select the “Day Off” Duty type, and the specify locations that it would apply to. Then highlight the hours that would mostly resemble a duty periodfor the trainees.

·   Caution: We have recently discovered that when trainees log their days off accounting for a period greater than 24 hours, the additional days were dropped and resulted in a day without log.  It is important that trainees specify their time off to reflect a period that would mostly resemble a shift, and not a 24 hour period.

·   Days off are not checked against any of the Duty Hour Rules. The GME office is requiring that Days off be logged, for reconciliation purposes, in order to ensure that all days are accounted for and avoid trainees leaving any days without logs.

 

o   Trainees must not log break time between rotations.  Gaps during shifts will result in a “Short Break” Violation.

·         Example of the above on clinic days (clinics logged as “Clinical Duties” like rotations)

o   JMH morning clinic and rotation at different sites

o   8-12pm (specify site) / 12-5pm Assigned Rotation (specify site)

o   Any clinic and rotation at same site: 8am – 5pm (specify site)

 

o   To log vacation / leave days – click on the “Log Vacation/Leave” box, located in the upper right hand corner of the screen; and indicate the starting date and ending date.

 

  

o   If a trainee is schedule to be on call from home – use the “Day Off” duty type (and specify the location it would apply to)

 

v  The time spent on-call from home is not reported, unless the trainee has returned to the hospital after being called in (this does not constitute a new shift).

 

v  To report the time spent on call at home use “Return to Hospital from Home Call” for time spent in the hospital while on at home call. 

 

·                     Fellows do not have to log activity less than 4 hours.

 

·                     Educational conferences are counted towards “clinical duties”

 

·         Once the trainee has logged his duty hours for the week (ie Saturday to Friday). He/she should review the logs for accuracy, making sure the correct duty type was identified and the location was selected.  The trainee should proceed to designate any vacation, leave or days off as “Did Not Work” days; and finally approve his hours for the week.

 

o   To designate your vacation / leave / days off as DNW days – 1. Click on “View Hours” from your duty hour log screen, then place a checkmark next to those days and click on the “DID NOT WORK” tab located at the bottom of the screen. DID NOT WORK days will appear in green.

 

o   To approve hours, place a checkmark next to the duty hours and click on the “Approve Hours” tab located at the bottom of the screen. Once the duty hours are approved, they cannot be modified or deleted.

 

o   Duty Hour Violations – will appear in red on the duty hour logs.

 

v  It is required that the trainee insert a comment documenting the reasons for the extended duty period that generated a violation. If the trainee erroneously recorded his duty hours, insert a comment indicating the discrepancy and identifying the corrected time if applicable. Once the Duty Hours are logged, violations will be identified and the justification for the Short Break Rule or 24+4 Rule is to be submitted by the resident. To do so, click on the Violations Tab. The trainee will be able to submit justification for review. The Program Director and Coordinator is then notified, and they can either request additional information, accept the justification (which will result in the removal of the violation), or decline and let the violation stand.

 

v  The 24+4 Rule and the Short Break Rule violations can be justified for intermediate level trainees or trainees in their final years of education, for the following reasons:

ü  To participate rare educational opportunity

ü  To care for a very ill patient

ü  To serve a patient or his family for humanistic purposes

ü  Schedule gaps is not a justified reason

 

Furthermore, the Cardiovascular Program will, in accordance with the Common Program Requirements:

  • Distribute these policies and procedures to the fellows and faculty
  • Monitor fellow duty hours, according to sponsoring institutional policies, with a frequency sufficient to ensure compliance with ACGME requirements
  • Adjust schedules as necessary to mitigate excessive service demands and/or fatigue
  • Monitor the demands of at-home call and adjust schedules as necessary to mitigate excessive service demands and/or fatigue.
  • Make sure the trainees get one day off in seven (averaged over 4 week period) completely free from all duty.

 Work Environment

·         The institution and the program must jointly ensure the availability of adequate resources for fellow education, as defined in the specialty program requirements.

·         Fellows must have clinical experiences in efficient, effective ambulatory and inpatient care settings.

·         There must be space and equipment for the educational program, including meeting rooms, classrooms, examination rooms, computers, visual and other educational aids, and work/study space.

·         Fellows must have lounge and food facilities during assigned duty hours.

·         When fellows are assigned night duty in the hospital or called in from home, they must be provided with on-call facilities that are convenient and that afford privacy, safety, and a restful environment with a secure space for their belongings.

Duty Hour Logging Guide Cardiovascular Fellowship Program

ACGME Mandated:  Daily duty hour logging

 

ASSIGNMENT

LOG AS

VIOLATIONS

 

Day time Regular Assignment

1.      Rotation Assignments

2.      Conferences/Research/Etc

 

Clinical Duties

Ø  Conferences are now counted as part of clinical duties.  No need to log separately

Ø  No need to log under the “Research” option

 

Violations will occur when conferences are logged separately, instead of part of the 8 hour work day (clinical duties).

 

Do not log break time between your conference attendance and return to rotation

 

On-Call – When in hospital

 

 

 

 

 

In House/Overnight Call

Ø  If on call, when your regular shift ends, switch from shift to on call. 

Ø  When you leave, switch it to call from home.

 

If the situation arises in which you leave the hospital late, either while on call or regular shift hours, you cannot return to the hospital until at least 8 hours.  If you do, and log the return, it will be a violation of the 10 hour rule.  You should either NOT return to the hospital until 10 hours are satisfied, and inform your attending and chief fellow, or recognize that this is your own voluntary time (and then should not be logged).

 

Example:  If you leave the hospital at 11pm while on call, you cannot return until 9am the next day.  If you return earlier, it will be a violation.  If you are needed earlier, contact your attending and chief fellow for coverage, OR make sure you leave by 1pm that day.

 

On-Call at home –

NOT Called-in to hospital

 

Call From Home/Pager Call (NOT CALLED IN)

Ø  No need to log

 

 

On-Call at home –

CALLED in to hospital

 

Return to Hospital from Home Call

Ø  Do NOT log as clinical duties

 

 

Only If An Emergency/Hurricane Situation Would Occur

 

On-Call in hospital more than 24 hours

 

If an Emergency Does Occur

1.      Clinical Duties during day

2.      In House/Overnight Call after hours

3.      Clinical Duties the next day

4.      Must leave at 1 pm next day

Working past 1 pm the following day

 

 

 

 

Cardiovascular Does Not Have  Overnight In-Hospital Call 

 

 

 

No Post Call Is Used

On-Call in hospital more than 24 hours

6 additional hrs are given - NO new patients are to be accepted during these 6 hrs

 

 

Moonlighting

 

Log as Moonlighting

Ø  Moonlighting counts toward the 80 work week limit!

 

 

Educational Leave

 

Log as Educational Leave

Ø  Use when attending national meetings, board reviews, etc.

 

 

Continuity Clinic

 

1.      Log as “Clinical Duties”.  A specific “Clinic” assignment choice is not available.

2.   Log a minimum of 4 hours. Make sure to specify the correct clinic site (UMH/JMH/VA)

3.   Only one consecutive “Clinical Duty” log is required when both your clinic and rotation are at the same hospital site.

Violations will occur when clinic is logged separately, instead of part of the 8 hour work day (clinical duties).

 

Do not log break time between your clinic and return to rotation.

 

Vacation or Leave

 

Log as Vacation/Leave

Ø  Click on the “Vacation/Leave” button in the upper right area of the screen.

Ø  Enter first day of vacation (should be a Monday) then enter the last day of vacation (should be a Sunday)

 


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