State Survey Gives Strong Memorial Clean Bill Of Health On Resident Work Hours
Finding Comes as Hospitals Throughout U.S. Adopt Work Hour Rules
June 30, 2003
Following a recent state inspection of residency programs at Strong Memorial Hospital, the New York State Department of Health has found that the Hospital is complying with state-established work hour limits for medical residents. The report comes as work hour limits pioneered in New York become a national standard.
Strong's survey, held from May 12th through May 22nd, involved interviews with residents in internal medicine, anesthesia, surgery, obstetrics/gynecology and pediatrics, as well as a review of work schedules and policies that relate to work hour limits, and consideration of previous surveys and resulting plans submitted by the Hospital to achieve compliance. Strong received notification from the state on June 19th that it is in compliance with the regulations, based on that survey.
In 1989, New York became the first in the U.S. to initiate strict rules, known as the "405 regulations," that ensure that physicians-in-training are properly rested. The regulations place an 80-hour per week limit on time worked and also specify rules such as how frequently residents may be "on-call" and how much unscheduled time they must be allowed per week. Over the last few years, the department has launched aggressive attempts to enforce the regulations.
Two years ago, the New York State Health Department retained IPRO to conduct surprise hospital inspections to ensure compliance with the 405 regulations. Results of IPRO's first year surveys showed 64% of New York's hospitals to be out of compliance, including Strong Memorial Hospital. Year-to-date results of IPRO's second-year surveys show than only 36% of hospitals remain out-of-compliance.
Diane Hartmann, M.D., associate dean for Graduate Medical Education at the University of Rochester School of Medicine and Dentistry, credits Strong's improvement to the "continued diligence of our residency program directors and administrators." She points to self-administered bi-annual anonymous surveys that require residents to keep work-hour diaries. "Conducting our own surveys has helped us to look under the rocks, then enlist the help of program directors and hospital administration to devise a solution." In 1998, the University of Rochester School of Medicine and Dentistry became the first in the state to develop its internal survey process, and has since shared its process with other New York hospitals.
According to Hartmann, full compliance has resulted from steps such as spreading on-call responsibilities across all levels of residents, not just first-year residents. The hospital has also adopted computer systems that make residents more efficient, and has devised systems whereby a group of residents work a night shift for several nights in a row, rather than being on-call for 24 hours or more. In some instances, Strong is now using attending physicians and nurse practitioners to perform duties once completed by residents.
In response to a growing national concern about medical errors that result from overworked, overtired residents, the Accreditation Council for Graduate Medical Education (ACGME) has now adopted similar regulations which apply to teaching hospitals throughout the nation. (The ACGME is an independent, non-profit organization formed in 1981 through the consensus of the medical community that accredits 7,800 residency program in the U.S.) The ACGME work hour regulations become effective tomorrow, July 1, 2003, a deadline that has prompted Hartmann's colleagues from around the country to contact her for advice.
"The ACGME rules are very consistent with New York's 405 regulations, so fortunately, the bulk of the work has already been done for many of our hospitals," Hartmann said. "I think that making these rules national is good because it places all teaching hospitals on the same playing field in the effort to ensure that residents receive the necessary rest to provide safe patient care."