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AHA takes stance on resident work hour rules, makes suggestions for ACGME

Hospitalist Leadership Connection, April 21, 2009

The American Hospital Association (AHA) on Monday released a statement to the Accreditation Council for Graduate Medical Education (ACGME) with recommendations for resident work hour rules. Like the Institute of Medicine (IOM), the AHA supports the 80-hour cap on resident hours, averaged over four weeks.

 “…We use duty hours as an implied proxy for measuring sleep and alertness,” according to the April 20 AHA statement. “This is, at best, an inadequate proxy because the hospital and residency program director have no information on what the resident actually did during the hours not on duty.”

Currently, the ACGME only counts on-site moonlighting hours in the allowable 80-hour standard. The AHA and the IOM propose that both on-site and off-site moonlighting hours should be counted toward the 80-hour limit.

Regarding on-call hours, the AHA supports maintaining the current ACGME standards of requiring residents to cover in-hospital call no more than every third night. The IOM, however, suggests some adjustment; it advocates that residents, at maximum, work in-hospital on-call every third night without averaging, as opposed to the current ACGME averaging rule.

The AHA also agrees with the ACGME that there be no change to time-off standards. The AHA and ACGME agree that residents should receive four days off per month, averaged over four weeks. However, the IOM recommends that residents get five days off per month with no averaging and at least one “golden weekend,” a 48-hour period per month.

In 2003, the ACGME adopted the ground-breaking resident 80-hour rule and promised to review it after five years. In 2007, the IOM charged the Committee on Optimizing Graduate Medical Trainee (Resident) Hours and Work Schedules to Improve Patient Safety to further evaluate the duty hours. In Dec. 2008, the IOM released its report, “Resident Duty Hours: Enhancing Sleep, Supervision, and Safety.”

As more hospitals consider cutting the number of resident positions and substituting them with hospitalists or advanced practitioners, the ACGME should clearly state the financial ramifications of new standards, according to the AHA.

Find a crosswalk of the current ACGME standards and IOM and AHA recommendations on HospitalistLeadership.com.

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