New Restrictions Will Cap Intern Hours

Starting in July of next year, interns will not be able to log more than 16 hours a day, according to new guidelines from the ACGME.

The Accreditation Council for Graduate Medical Education (ACGME) has given final approval to new hour restrictions for residency programs that will take effect in July 2011. Residents will still be allowed to work a total of 80 hours per week; however, interns will no longer be able to log more than 16 hour per day and will face graduated requirements for minimum periods of time off between shifts.

According to a statement from the ACGME, the new requirements are “designed to better match residents' levels of experience and emerging competencies, advancing both graduate medical education and safe quality patient care in the nation’s teaching hospitals.”

The standards are based on recommendations made by the Institute of Medicine in 2008 and evidence collected during a 16-month review of scientific literature on sleep issues, patient safety, and resident training. The task force listened to testimony from more than 100 experts, and received and reviewed statements from 100 medical organizations.

In addition to retaining the current duty hour limit of 80 hours per week, averaged over four weeks, the standards specify more detailed directives for levels of supervision necessary for first-year residents, and set stricter requirements for duty hour exceptions.

In an effort to raise the standards, the ACGME set higher requirements for teamwork, clinical responsibilities, communication, professionalism, personal responsibility, and transitions of care. Other items the new requirements address include:

  • Expanding program and institutional requirements regarding handovers of patient care;
  • Setting more specific requirements for alertness management and fatigue mitigation strategies designed to ensure both continuity of patient care and resident safety.

Implementing these standards, said Thomas Nasca, MD, CEO of ACGME and vice chair of the task force that developed the standards, “will require small change in some programs and large changes in others, all with the goals of ensuring patient safety, that the next generations of physicians are well-trained to serve the public and that residents receive their training in a humanistic learning environment.”

An Institutional Patient Safety and Quality Assurance review, approved by the ACGME board, is being created that will begin to ensure compliance with the new standards. Under this program, the ACGME will review every institution sponsoring graduate medical education programs, examining their ability to integrate residency education, supervision and fatigue management into their existing patient safety and quality improvement initiatives. An advisory panel comprised of national patient safety experts has been meeting with ACGME to help establish this process.

What do you think of these new standards? Can limiting hours play a role in improving patient safety?