Introduction: In 2003 the Accreditation Council for Graduate Medical Education (ACGME) instituted the 24+6-hour duty schedule and 80-hour work week (1, 2). On July 1, 2011, the ACGME mandated a 24+4-hour duty schedule, 8 hours off between shifts, and 14-hours off after a 24-hour call period for training after the initial postgraduate year, while maintaining the 80-hour week (Table 1) (1, 2). In anticipation of the new standard, the Oregon Health & Science University (OHSU) neurosurgery residency program instituted a 3-person night float system. We analyzed work hour violations and number of operative cases performed before and after institution of this system.
Methods: A 3-person night float system was instituted on January 1, 2011 (Figure 1). We analyzed work hours and operative caseload for the years prior (2010) and after (2011) implementation of the new system. The 2011 ACGME work hour standards were applied to both time periods and work hour violations and operative cases performed were counted for PGY-2, PGY-3, PGY-4, PGY-5 and PGY-7 residents.
Results: After implementation of the 3-person night float system, a reduction was seen in all work rule violations. The total number of violations significantly decreased from 197 to 47 (Figure 2). No difference was seen in the number of operative cases performed per year by any level resident. The total number of cases performed was not significantly changed, from 3442 to 3531 (Figure 3).
Conclusions: To meet the new ACGME work hour standard OHSU neurosurgery instituted a 3-person night float system. This required reducing the number of research years from 2 to 1.5, providing a third resident to participate in the night float rotation. This resulted in a reduction of work hour violations without change in the resident operative caseload.
Patient Care: Better understanding of how work hour restrictions effect operative caseload.
Learning Objectives: 1. Identify possible work hour solutions to the July 1, 2011 ACGME standard.
2. Describe ACGME work hour restriction violations in neurosurgical residency training.
3. Identify advantages and disadvantages to a 3-person night float system.
References: 1. Duty Hours: ACGME Approved Standards, Effective July 1, 2011: ACGME Resident Duty Hours. Chicago, IL, Accreditation Council for Graduate Medical Education (ACGME), 2010, pp 1-19.
2. Resident Duty Hours in the Learning and Working Environment, Comparison of 2003 and 2011 Standards: ACGME Resident Duty Hours. Chicago, IL, Accreditation Council for Graduate Medical Education (ACGME), 2010, pp 1-7.
3. Martin MD and CE Wolfla. ACGME-Mandated Work Hours: Implementation at the University of Oklahoma: American Association of Neurological Surgeons Bulletin, Winter 2005, p 14-16.
4. McCall, T, G Rao and J Kestle. Work Hour Restrictions: Impact on Neurosurgical Resident Training at the University of Utah: American Association of Neurological Surgeons Bulletin, Winter 2005, p 17-23.