Work Hours Reform

In 1989, CIR helped shape New York State’s regulations that set maximum work hour limits for housestaff. Since then, CIR members have negotiated hours limitations and program security clauses in Miami, Los Angeles and Boston. These important advances have become models for improving residency programs across the country.

CIR continues to work to establish evidence-based work hour scheduling for resident physicians that optimizes the quality of patient care, resident education, and safety.


HoursWatch.org

• HoursWatch.org is dedicated to establishing evidence-based work hour scheduling for resident physicians that optimizes the quality of patient care, resident education, and safety.  HoursWatch.org is jointly sponsored by CIR and the American Medical Student Association (AMSA), two organizations with a long history of commitment to improving medical education and training.

The Science: Work hours and the link to resident and patient safety

•  Key scientific studies – from HoursWatch.org
•  Striving for an Evidence-based Standard for Resident Work Hours: What the data and research tell us.
•  Dying to Sleep: A legal review of driving while drowsy legislation and hospital liability for resident work hours.

Best Practices: Implementing a 16-hour shift

• Internal Medicine, Summa Health System: A video documenting how an Akron, Ohio program has successfully reduced on-call shifts to no more than 16 hours, without hiring any additional staff.
• Shorter Hours, Fewer Nights: Life as a British Resident: To U.S. physicians, limiting resident work hours to 48 per week seems unimaginable. But to Elisabeth Paice, FRCP, dean of postgraduate medical education in London, it’s all part of effective medical training.
• Capping Hours at 12: Overcoming resistance at Coney Island Hospital in Brooklyn, NY to reforming resident work hours.
• Alert & Awake For Everyone's Sake: A Resident Work Hours Conference in New Zealand, where there have been a maximum of 16-hour shifts and 72-hour weeks since the mid-1980s.
• Multiple examples of implementation – from HoursWatch.org
• The Case for 16 Hours: Dr. Christopher Landrigan of the Sleep and Patient Safety Program uses a PowerPoint presentation to make his case based on the evidence.
• 3 Case Studies: Reducing Resident On-Call Shifts to ≤ 16 Hours: How did programs at Seattle’s Virginia Mason Medical Center, Akron’s Summa Health System and New York’s St. Luke’s-Roosevelt reduce their maximum on call shifts to 16 hours or less?  CIR News reports on these three case studies.

The Institute of Medicine Report, Linking Resident Work Hours and Patient Safety
* NEW: Déjà Vu All Over Again: Why The New ACGME Rules Are Unlikely to Improve Patient & Resident Physician Safety , submitted to the ACGME as public comment on August 9, 2010

• The Impetus for the IOM report: The U.S. House of Representatives Committee on Energy and Commerce’s letter to the Agency for Healthcare Research and Quality (AHRQ).
• The IOM report in entirety
• Summary of the IOM report
• CIR's Press Release in Response to the IOM Report
• AHRQ’s Press Release in Response to the IOM Report: Includes resources to help residents and other health care providers implement recommendations related to patient safety training and adverse event reporting
• CIR President Dr. L. Toni Lewis Testimony before the IOM Committee: Washington DC, December 3, 2007
• Former CIR National Vice-President Dr. Nailah Thompson Testimony before the IOM Commttee: “Driving While Drowsy: The Threat to Resident Physicians & Public Safety.” Irvine, CA, March 4, 2008
• CIR's Testimony before the ACGME Duty Hours Congress, Chicago, IL, June 12, 2009