Office of Graduate Medical Education Duty Hour Policy - Duke University Hospital

• Duty hours are defined as all clinical and academic activities related to the graduate medical education program, ie, 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.
• Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities.
• Trainees must be provided with 1 day in 7 free from all educational and clinical responsibilities, averaged over a 4-week period, inclusive of call. One day is defined as one continuous 24-hour period free from all clinical, educational, and administrative activities.
• Adequate time for rest and personal activities must be provided. This should consist of a 10-hour time period provided between all daily duty periods and after in-house call.
• No new patients may be accepted after 24 hours of continuous duty

• In-house call must occur no more frequently than every third night, averaged over a four-week period.
• Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Trainees may remain on duty for up to 6 additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics and maintain continuity of medical and surgical care (unless further limited by the relevant Program Requirements).
• No new patients may be accepted after 24 continuous hours on duty. A new patient is defined as any patient for whom the trainee has not previously provided care (unless otherwise defined in the relevant Program Requirements).
• At-home call (pager call) is defined as call taken from outside the assigned institution.
  • The frequency of at-home call is not subject to the every third night limitation. However, at-home call must not be so frequent as to preclude rest and reasonable personal time for each trainee. Trainees taking at-home call must be provided with 1 day in 7 completely free from all educational and clinical responsibilities, averaged over a 4-week period. 
  • When trainees are called into the hospital from home, the hours trainees spend in-house are counted toward the 80-hour limit. 
  • The program director and the faculty must monitor the demands of at-home call in their programs and make scheduling adjustments as necessary to mitigate excessive service demands and/or fatigue.

• Because graduate medical education is a full-time endeavor, the program director must ensure that moonlighting does not interfere with the ability of the trainee to achieve the goals and objectives of the educational program. Requests for moonlighting will be evaluated on a case by case basis.
• The program director must comply with the sponsoring institution's written policies and procedures regarding moonlighting, in compliance with the ACGME Institutional Requirements III. D.1.k.
• Moonlighting that occurs within the graduate medical education program and/or the sponsoring institution or the non-hospital sponsor's primary clinical site(s), ie, internal moonlighting (Temporary Special Medical Activity), must be counted toward the 80-hour weekly limit on duty hours.
• Requests for Temporary special Medical Activity will include documentation of duty hours.
  
  

• Each program must have written policies and procedures consistent with the Institutional and Program Requirements for resident duty hours and the working environment. These policies must be distributed to the trainees and the faculty. Monitoring of duty hours is required with frequency sufficient to ensure an appropriate balance between education and service.
• Back-up support systems must be provided when patient care responsibilities are unusually difficult or prolonged, or if unexpected circumstances create trainee fatigue sufficient to jeopardize patient care.
• Surveillance of duty hours will be the continuing responsibility of the Trainee Section of the Institutional Committee for Graduate Medical Education (ICGME) who will report to the full ICGME at least biannually.
• Violations of the duty hour standards may result in institutional sanctions, such as withdrawal of program sponsorship or Corrective Actions for Associate Members of the Medical Staff.