Elsevier

Journal of Surgical Education

Volume 69, Issue 3, May–June 2012, Pages 355-359
Journal of Surgical Education

Original report
Limiting PGY 1 Residents to 16 Hours of Duty: Review and Report of a Workshop

Presented at the annual meeting of the Association of Program Directors in Surgery, March 2011.
https://doi.org/10.1016/j.jsurg.2011.10.013Get rights and content

Background

In 2003, the Accreditation Council for Graduate Medical Education (ACGME) instituted limits on duty hours. Residents were restricted to working 80 hours/week and limited to 24 hours of continuous patient care. Effective July 2011, an additional restriction will be instituted for PGY 1 residents limiting continuous duty to 16 hours maximum.

Objective

Prospective evaluation of the impact of the upcoming work shift limitations for PGY 1 residents.

Design/Setting/Participants

Review of literature and discussions among program directors, program coordinators, and residents on the effects of prior limitations of duty hours, as a point of reference, to manage the changes of duty hours for PGY 1 residents during a workshop at the Association of Program Directors in Surgery Annual Meeting.

Results

Work-hour restrictions necessitate a change from the traditional 24-hour on-duty call schedule for PGY 1 residents. The benefits to patients of being treated by less tired doctors working in shifts may be offset by communication failures from poor handoffs, rendering the system prone to adverse events/near misses. With additional work-hour restrictions, it is imperative to anticipate problems and deal with them effectively. Continued reevaluation of the handoff system and efforts made to decrease the number of preventable adverse events that typically occur during periods of cross coverage should be undertaken. Labor costs to carry out these new restrictions are predictably high but can be made budget neutral if improvement in patient care leads to reduction in the costs of corrective actions.

Conclusions

Residency programs have adapted to the 2003 work-hour restrictions without apparent ill effect. We must study the effects of the July 2011 requirements prospectively as the traditional frontline physicians (PGY 1 residents) will no longer be available for 24-hour duty shifts.

Section snippets

Background

The death of Libby Zion in 1984 set off a series of events that led ultimately to the formation of the Bell Commission in New York State in 1989; subsequently, New York State adopted the 80-hour workweek, with the restriction of the work shift to 24 consecutive hours, with 3 additional hours for handoff followed by a mandatory period of 8 hours off duty.1 In 2003, the Accreditation Council for Graduate Medical Education (ACGME) mandated somewhat similar work-hour restrictions for all residents

The Workshop

In anticipation of the implementation of the new work-hour restrictions for PGY 1 residents, we conducted a workshop at the Association of Program Directors in Surgery (APDS) Annual Meeting in Boston, Massachusetts on March 25, 2011. The workshop entitled “Brainstorming on how to deal with the effects of the maximum 16 hour work shift for the PGY 1 surgical resident” attracted approximately 50 programs directors, residency program coordinators, and residents. The group reported preparing for

Outcomes

Shortly after our workshop, a complete systemic review in the British Medical Journal concluded that the reduction of duty hours had limited impact on postgraduate training and minimal effect on patient outcomes in the United States.21

The workshop group agreed collectively that in trying to improve the handoff system, we should learn from others (such as those in the aviation industry), by emphasizing efficiency, safety, and education. The handoff should be both written and oral, and it should

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