CHICAGO, July 29, 2004 – One year after the Accreditation Council for Graduate Medical Education implemented its common duty hour standards for residents, data indicate that most programs are in compliance. The data also shows that programs are using innovative scheduling and staffing adjustments to comply with the duty hour standards.
“The ACGME is gratified by the response of the teaching hospitals in the United States as they met the challenge of implementing the duty hour reform for residents,” said David C. Leach, MD, executive director of the ACGME. “Major redesign of the system of health care is needed, and we still have a long way to go before we get it right. However, much has been learned in the last year. Individual accountability has been enhanced by team accountability. We are building knowledge about good learning for good patient care.”
The ACGME implemented its common duty hour standards on July 1, 2003 for the nearly 8,000 residency programs accredited by the ACGME. Residents cannot be on duty more than 80 hours a week, averaged over four weeks; must have one day in seven free of clinical and educational duties; cannot be on call more than one night out of three; and cannot work more than 24 consecutive hours plus six additional hours for patient handoffs. Programs in some specialties may apply for a 10% increase in the weekly duty hours if they can demonstrate an educational benefit for residents and receive approval from the ACGME residency review committee for that specialty. Programs that violate the standards are subject to adverse accreditation actions, including probation and withdrawal of accreditation. Programs that lose accreditation cannot receive Medicare graduate medical education funds, and their residents are not eligible to take board certification examinations.
Over the past year, the ACGME has been closely tracking compliance with the duty hour standards. Field staff interviewed between 11,000 and 13,000 residents during scheduled accreditation site visits. The ACGME collected data on duty hour compliance from directors of all accredited programs, which was verified by senior officials at the sponsoring institutions.
The ACGME also gathered duty hour compliance data from 25,176 residents in 1,489 programs through an Internet survey. Survey data show that 834 residents (3.3% of the total responding) reported working more than 80 hours a week during the previous four weeks. The ACGME is following up with programs where survey data indicate possible problems with duty hour compliance.
Of the 2,019 programs that underwent accreditation reviews from July 1, 2003 to June 30, 2004, 99 programs (4.9%) received one or more citations related to duty hours. Most of the citations (51) were for violations of the 80 hours a week limit, followed by 27 citations each for violations of the one day free out of seven and 24-hour-plus-six standards.
The ACGME received 53 resident complaints about duty hour violations. The ACGME took follow-up action on 42 on those complaints. Actions included monitoring the programs, putting them on probation, issuing warnings, scheduling site visits and requesting the programs to provide compliance progress reports. Eleven complaints were dismissed as unfounded.
During the past year, 92 programs petitioned to increase resident duty hours to 88 hours a week; 75 requests were granted and 17 were denied. The majority of programs requesting the increase were in the specialties of neurological surgery, general surgery, thoracic surgery and orthopaedic surgery. In February, the ACGME Board of Directors rejected a request from some of the surgical RRCs to allow chief residents in surgical specialties to work up to 88 hours per week; the Board determined that such requests could be addressed through the current procedure allowing up to 10% increases in duty hours on a program-by-program basis.
The full duty hours report, "The ACGME’s Approach to Limit Duty Hours 12 Months After Implementation,” is available on the ACGME’s Web site, www.acgme.org.
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The ACGME is a private, non-profit council that accredits 7,800 residency programs
in 27 specialties affecting 100,000 residents. Its mission is to improve the quality
of health care in the United States by ensuring and improving the quality of graduate
medical education for physicians in training.
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