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Beginning in July 2003, UW Medicine residency training programs were adjusted to comply with new accreditation standards that limit resident duty hours. The Accreditation Council for Graduate Medical Education (ACGME) instituted the national standards to promote quality training and patient care, as well as to protect patient safety.
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In general, the standards limit resident duty to 80 hours per week, schedule residents for in-hospital call no more than every third night, and give residents one 24-hour day off per week free of patient care and educational responsibilities. These requirements are averaged over four weeks.
The standards also limit continuous resident duty to 24 hours, but allow up to six hours additional time for continuity of care and educational activities. Residents must also have at least 10 hours off for rest between duty periods.
The standards apply to all residency programs in any of the ACGME’s 118 accredited specialties and sub-specialties.
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| Surgery residents John VerHalen (left) and Adam Lipson |
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The UW departments of medicine and surgery, with the largest numbers of residents, began implementing some program changes in anticipation of the new standards nearly a year before the required date.
UW Medicine established an Ad Hoc Steering Committee to recommend compliance strategies. On the basis of these plans, approvals were granted for 34 new residency positions in several different programs. Both UW Medical Center (UWMC) and Harborview Medical Center hired additional nurse practitioners and physician assistants. At UWMC, six new mid-level positions were projected to meet patient care needs that could no longer be provided by residents. In some instances, new hospital-based physicians were added.
In addition, a thorough review of resident workload has led to process improvements that reduce paperwork and increase efficiency. Changes in resident call schedules and conference schedules also have been made.
The UW Graduate Medical Education Committee is writing plans for ongoing monitoring of compliance in the 67 residency programs offered in Seattle.
The ACGME will monitor compliance through confidential Internet resident surveys, as well as through interviews during accreditation site visits.
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