ACGME Duty Hour Guidelines Background

On July 1, 2003, a change in resident duty hour guidelines was implemented. These guidelines were adopted in February 2003 by the Accreditation Council for Graduate Medical Education (ACGME), an independent organization responsible for the accreditation of nearly 7,800 residency programs, including 110 specialty and subspecialty areas of medicine.

Residents have long been utilized by academic medical institutions and hospitals with residency programs, with the mutually beneficial goal of educating and providing clinical experience for physicians-in-training. However, over the years, hospitals have come to rely on residents in excess of 80-120 hours per week. Although beneficial and part of the clinical education process, such practices have also come to be recognized as negative to resident health and more importantly, patient care and safety.

The following are the resident duty hour requirements applicable to all residency programs accredited by ACGME.

• Duty hours are limited to 80 hours per week, averaged over a four-week period, including all in-house call activities. Duty hours include all clinical and academic activities related to residency, including patient care, administrative duties of patient care, transferring patients, in-house call activities, and scheduled academic conferences or seminars.
• Continuous, on-site duty (including in-house call) cannot exceed 24 consecutive hours. Residents may stay on duty up to 6 additional hours to transfer patients, staff outpatient clinics, or maintain continuity of care. No new patients, however, may be accepted after 24 consecutive hours.
• At-home call (pager) is not limited per se, however, it must allow for rest and reasonable personal time. When residents are paged at-home and come to the hospital, the in-house hours count toward the 80-hour limit.
• Minimum of 10 hours of rest between duty periods.
• Residents must also have 1/7 days free from all educational and clinical responsibilities, averaged over a 4-week period; this day must be free from all clinical, educational, administrative, and on-call activities.

Moonlighting that occurs within the residency program and/or sponsoring institution or primary clinical site is counted toward the 80-hour weekly limit.