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Institute of Medicine releases suggested changes to duty hour standards

Residency Program Connection, December 9, 2008

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Last week, the Institute of Medicine (IOM) released a report calling for several changes to the ACGME duty hour regulations. The report, Resident Duty Hours: Enhancing Sleep, Supervision, and Safety, advocates for protected sleep time for residents, increased supervision of residents, and more effective hand-off processes, all of which could cost health care organizations as much as $1.7 billion to implement.

The organization does not call for cuts to the current “80-hour averaged over four weeks” rule. Instead, it proposes the following modifications:

• During 30-hour shifts, residents should admit patients for up to 16 hours, have 5 hours of uninterrupted sleep between 10 p.m. and 8 a.m., and spend the remaining hours on transitional and educational activities. (Currently, residents can admit patients for up to 24 hours and spend the remaining six hours on transitional and educational activities).
• If there is no protected sleep time, residents’ shifts should only be 16 hours.  .
• Time off between shifts should be changed from 10 hours after a shift to the following: 10 hours after day shift, 12 hours after night shift, and after an extended duty of 30 hours, residents get 14 hours, and they can’t return to work until 6 a.m. the following day.
• Mandatory time off should be increased from four to five days per month; residents should get one day off per week (no longer averaged over four weeks), and one 48-hour period off every month.
• New duty hour rules should apply to all internal and external moonlighting.

Several organizations, including medical associations and consumer groups, are responding to the IOM’s suggestions. Although many applaud the report, some are not in favor with the findings. While consumer organizations call for federal monitoring of duty hours, some medical socities raise concerns that work hour restrictions reduce residents' educational time. For summaries and links to various organizations’ statements, see our post on Residency Manager Blog.

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