To provide an Institutional Statement regarding resident duty hours and the working environment in compliance with ACGME requirements.
The Radiology Residency Program is to schedule resident assignments to be in compliance with all applicable ACGME requirements. Duty hour assignments must recognize that faculty and residents collectively have responsibility for the safety and welfare of patients. The program must be committed to and be responsible for promoting patient safety and resident well-being and to provide a supportive educational environment. This policy is to be communicated to the residents and faculty annually and applies to all participating sites where residents are trained. On a quarterly basis, residents must log their duty hours for a 28-day period. The duty hour report will be submitted to the GMEC for review.
Duty Hours: all clinical and academic activities related to the program. This includes patient care, administrative duties relative to patient care, provision of transfer of patient care, on-call time spent in-house, and scheduled activities such as conferences. Duty hours do not include reading and preparation time spent away from the duty site.
External moonlighting: Voluntary, compensated, medically-related work performed by a resident of Santa Barbara Cottage Hospital Radiology Residency Program at a place which is NOT used by the residency program for training.
Internal moonlighting: Voluntary, compensated, medically-related work performed by a resident of Santa Barbara Cottage Hospital Radiology Residency Program at this hospital or at any other sites used by the residency program for training.
Scheduled assignments: Assigned duty at Santa Barbara Cottage Hospital or other training sites.
1. Weekly limit: Duty hours are limited to 80 hours per week, averaged over a four-week period,inclusive of all in-house call activities and all moonlighting (both external and internal).
a. Moonlighting must not interfere with resident education.
b. Moonlighting is only permitted with written approval of the Program Director.
2. Mandatory Days off: Residents must have one day (24 hour period) every week free of all duty , when averaged over the four weeks of the rotation.
3. Maximum duty period length:
a. Duty periods of radiology residents are limited to 24 hours of continuous duty in the hospital or other training site. The resident may remain on-site for transition of care and/or to attend an educational conference when that transition is completed, but may not perform additional clinical duties during those additional 4 hours. The program encourages the resident to use alertness management strategies in the context of patient care responsibilities.
b. In the rare circumstance of 16 hours of continuous duty, residents are encouraged to engage in strategic napping, especially between 10:00 pm and 8:00 am.
4. Individual exception to maximum duty hour period: In unusual circumstances, residents, on their own initiative, may remain beyond their scheduled period of duty to continue to provide care to a single patient. Justifications for such extensions of duty are limited to reasons of required continuity for a severely ill or unstable patient, academic importance of the events transpiring or humanistic attention to the needs of a patient or family.
a. The residents must appropriately hand over the care of all other patients to the team responsible for their continuing care and document the reasons for remaining to care for the patient in question and submit that documentation to the Program Director.
b. The Program Director must review and track each submission of additional service.
5. Minimum time off between scheduled duty periods:
a. Radiology residents in their first, second and third year of training are considered to be at the intermediate level. Intermediate level residents should have 10 hours, and must have 8 hours free of duty between scheduled duty periods. They must have at least 14 hoursfree of duty after 24 hours of in-house duty.
b. Radiology residents in their fourth year of training are considered to be in their final year of training. Final year level residents must be prepared to enter the unsupervised practice of medicine and care for patients over irregular or extended periods.
i. This preparation must occur within the context of the 80-hour, maximum duty period
length, and one-day-in-seven standards.
ii. While it is desirable that residents in their final years of education have eight hours free of duty between scheduled duty periods, there may circumstances when these residents must stay on duty to care for their patients or return to the hospital with fewer than eight hours free of duty. These circumstances of fewer than eight hours away from the hospital must be monitored by the Program Director.
6. Maximum frequency of in-house call: must not be scheduled for more than six consecutive nights and no more than every-third-night (when averaged over a four-week period). There is no at-home call.