The Accreditation Council for Graduate Medical Education (ACGME) has reduced extended duty hours for residents, which now cannot exceed 16 hours unless a five-hour nap is provided between 10:00 p.m. and 8:00 a.m. The proposed requirements were published June 23 in the New England Journal of Medicine. After five-hour nap, residents may continue for up to nine more hours for a total of 30 hours.
Under the new proposals, residents cannot see any new patients after 16 hours, and extended duty (e.g., 30 hours with a five-hour nap) must not occur more frequently than every third night.
In July 2003, the ACGME enacted resident duty-hour standards for all accredited programs that sought to integrate limits on resident hours within the larger set of ACGME standards. The association said the aim of these standards was to promote learning and safe care in teaching institutions. At the time, the association promised the profession that it would revisit them in five years.
In 2003, the association noted that continuous onsite duty, including in-house call, must not exceed 24 consecutive hours. At that time, the group decided that residents may remain on duty for up to six additional hours, but could not accept any patients after 24 hours of continuous duty.
For these updated recommendations, the ACGME commissioned a 16-member task force to review relevant research, hear testimony and draft new standards. The association received position statements from more than 100 medical organizations, heard personal testimony and held discussions with members of the Institute of Medicine committee, patient advocates, sleep physiologists and experts on patient safety and quality of care, educators and international medical educators with experience in systems with greater restrictions on resident hours.
The standards will be available for comment on the ACGME website until Aug. 9. The enhanced standards will be put into effect in July 2011, at which time institutional site visits will also begin.