A Commission of the NY State Department of Health, headed by
Dr. Bertrand Bell, developed regulations regarding the
SUPERVISION of residents and WORK HOUR LIMITATIONS. These
were first implemented in 1989. Hospitals are subject to
substantial fines for repeatedly violating these
regulations, and all departments of this Hospital strive to
be in compliance, so please let your program director know
if you believe we are not in compliance with the
regulations. Nevertheless, professional conduct by
residents requires that they provide patient care first, and
then discuss any potential violations with the program
director. In fact, residents are asked to fill out
surveys for their program director at least twice a year to
document compliance with the NYS "Bell Commission"
regulations. The ACGME has similar supervision and work
hour regulations.
A summary of these supervision and work hour regulations, as
they apply on the medical service, follows:
1) No more than 12 consecutive hours on call in the ER.
This also means that one must not attend conferences or clinics
before or after such 12 hour shifts.)
2) On the inpatient service, no more that 80 hours of work
per week (based on a 4 week average). Some weeks may be somewhat
more than 80 hours, as long as other weeks are less than 80
hours, and the average, over 4 weeks, does not go over 80 hours
work per week.
3) No more than 24 consecutive hours on call (as might
occur on the medical service when there is no Night Float, or in the
ICU when one is on long call), but up to an additional 3 hours
(after the 24) is allowed if it is necessary as "transitional time"
for sign out activities (but not work or direct patient care such
as drawing blood or starting IVs).
4) At least 10 hours off between shifts with at least one 24
hour period scheduled nonworking time a week.
5) Moonlighting, if permitted by the Program Director, must
not violate the above regulations.
6) Procedures must not be performed on your own unless you
have received written privileges per our credentialling
process.
7) You must be aware of the CHAIN of COMMAND in the area in
which you are working. This is to ensure that you receive
adequate SUPERVISION and than an attending physician is aware of
each patient and can participate in management decisions and
direction of the patient's care.
8) If you observe a colleague who appears overtired, or if
you are overtired, notify your more senior resident so that
action can be taken to find a replacement physician.
9) On the in-patient medical rotations, the ACGME requirement is that
a PGY-1 should not be assigned more than 5 new patients
per admitting day and not more than 8 new patients within a
48 hour period. Admissions are to be assigned to other PGY-1,
2, or 3 if necessary to satifsy these guidelines. PGY-1 residents
should not be responsible for more than 12 in-patients. When
supervising PGY-1 residents, PGY-2 or PGY-3 should not
be responsible for the ongoing care of more than 24
patients. PGY-2 or 3 should not be responsible for admitting more
than 10 new patients per admitting day or more than 16 new
patients in a 48 hour period.
