Duty Hours & Record Keeping
Resident Duty Hours
The Department of Surgery requires that the residency training programs foster both quality resident education and facilitate quality patient care. Overall, resident duty hours in all programs must be consistent with the Institutional and specific program Residency Review Committee (RRC) accreditation requirements established by the Accreditation Council for Graduate Medical Education (ACGME). The structuring of duty hours and on-call schedules focus on the needs of the patient, continuity of care and the educational needs of the residents.
Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all patient care activities, inclusive of all in house clinical and educational activities, clinical work done from home, and all moonlighting.
Residents must be provided with 1 day in 7 free from all educational and clinical responsibilities, averaged over a 4-week period, inclusive of call. One day is defined as one continuous 24-hour period free from all clinical, educational, and administrative activities. At home call cannot be assigned on these free days
- Adequate time for rest and personal activities must be provided. Residents should have 8 hours off between scheduled clinical work and education periods. There may be circumstances when residents choose to stay to care for their patients or return to the hospital with fewer than 8 hours free of clinical experience and education. This must occur within the context of the 80-hour and the one-day-off-in-seven requirements.
- Maximum Clinical Work and Education Period Length Clinical and education work periods for residents must not exceed 24 hours of continuous scheduled clinical assignments. Up to four hours of additional time may be used for activities related to patient safety, such as providing effective transitions of care, and/or resident education. Additional patient care responsibilities must not be assigned to a resident during this time.
- Clinical and Educational Work Hour Exceptions In rare circumstances, after handing off all other responsibilities, a resident, on their own initiative, many elect to remain or return to the clinical site in the following circumstances: to provide care to a single severely ill or unstable patient; humanistic attention to the needs of a patient or family; or to attend unique educational events. These additional hours will all be counted toward the 80-hour weekly limit.
- Residents must be given the opportunity to attend medical, mental health, and dental care appointments, including those scheduled within work hours
- In addition to specific work hours, residents and faculty need to be cognizant and concerned about fatigue. Any fatigue concerns should be addressed with the supervising attending. Strategic naps are encouraged. Nap rooms are provided in the House Staff Sleep Quarters during normal day hours and prior to driving home. App-based transportation service is available in extreme cases of fatigue
- All residents and faculty members must demonstrate responsiveness to patient needs that supersedes self-interest. This includes the recognition that under certain circumstances, the best interests of the patient may be served by transitioning that patient’s care to another qualified and rested provider
- It is everyone’s responsibility to abide and work within the work hour policy. Faculty must remain vigilant of the trainees under their supervision and frequently monitor the residents’ activities. Residents must stay within the work hours and notify chief/senior residents, faculty, and / or the program director if they are having difficulties in meeting daily or weekly work hour requirements. Residents should notify their program director and/or the Sr. Associate Dean for Graduate Medical Education if their assigned hours are not in compliance with UCLA or ACGME work hour policy.
Residents are required to report and log all duty hours in MedHub. Residents must log in at least once every week. The Program Director and coordinator will run reports on a weekly basis to review each resident's reported duty hours to ensure compliance and address potential violations.
Duty Hour Noncompliance
In the circumstance where a resident recognizes that he or she will be noncompliant with duty hours, he or she must notify the chief resident, service faculty member, and program director. Accommodation will be arranged immediately to bring the hours back into compliance. Duty hours are reviewed weekly by the program coordinator and program director. Residents who have not entered duty hour logs will be asked to complete these. Completing duty hour logs is a matter of professionalism and the resident will be judge on this. If a duty hour issue is identified by the program director, the program director will contact the resident in order to understand the circumstances that led to the violation. Corrective action will be arranged with the service in order to bring the resident back into compliance.
All residents need to have enough time without clinical responsibilities to stay well-rested and avoid fatigue while on duty. Residents receive instruction annually on issue of fatigue, sleep, and napping.
Residents that have fatigue symptoms at any point could jeopardize patient care. These symptoms include falling asleep, irritability, apathy, and careless medical errors. Residents are required to consult immediately with other members of the team including service faculty, and inform the program director so that the resident may be immediately be relieved of duty. Patient care should then be delivered by other members of the team or by a faculty member. Call rooms at each site are available 24 hours a day for strategic napping. It is the responsibility of the fatigued resident to take advantage of time away for rest.
Medical Record Keeping
The purpose of Medical Record Keeping is to inculcate in trainees the importance and process of appropriate and timely medical record documentation and completion. All trainees in Core Surgical and General Surgery Training Programs, at all institutions, are expected to ensure that the following criteria is followed for appropriate documentation of patient care activities:
- All signatures will be accompanied by a printed name or pager ID number so that the signer can be identified.
- All notes and orders written by medical students are co-signed by a resident physician or attending physician.
- All patients admitted to an in-patient service will have a history and physicalperformed and recorded by a resident physician within twenty-four (24) hours of admission.
- A brief operative reportwill be completed in the medical record indicating the following:
- preoperative diagnosis
- postoperative diagnosis
- operation performed
- attending surgeon
- resident surgeons(s)
- anesthetic used
- estimated blood loss
- parenteral fluid administered
- urine output
- drains placed
- specimens obtained
- pertinent findings and any apparent complications
- In the immediate postoperative period (2-5 hours), a postoperative progress note in SOAP format will be documented for all inpatients
- Each patient will have a daily progress note, completed in SOAP format, documented in the medical record noting the patient's current status requiring hospitalization, pertinent physical findings, and any active intervention being provided.
- All invasive procedures will be documented by a procedure notecontaining the following information:
- indication for procedure
- documentation that informed consent was obtained
- procedure performed
- supervising resident or attending physician
- anesthetic used
- pertinent findings and any apparent complications
Any significant event occurring in the course of a patient's care will be documented.
This includes the following situations:
- confusion or delirium resulting in the need for physical restraint or chemical sedation
- deterioration in a patient's clinical condition
- the need to escalate the level of intervention or care for a patient
- any belligerent, threatening, or hostile actions, either physical or verbal, on the part of the patient, or any of the patient's family members.
A discharge summary will be completed for all inpatients at the time of discharge from the hospital.
Completion of the Medical Record: All trainees are expected to complete medical records in an accurate and timely manner.
- UCLA Medical Center: policy regarding delinquent medical records is established by the Medical Staff ByLaws. "All individuals with clinical privileges (Medical Staff and House Staff) are required to complete discharge summaries in a timely manner. Clinical privileges of Medical Staff members and House Officers who have 3 discharge summaries delinquent more than 14 days, (when the chart is available) or 1 discharge summary delinquent more than 30 days shall be immediately suspended and clinical privileges (admitting, consulting, and surgical) rescinded; this shall include charts without signatures. The suspension will be in force until such time as the delinquent medical records are completed."
- West Los Angeles VA Medical Center: medical records delinquent for greater than fourteen (14) days when the chart is available, will be reported to the Program Director for action.
- Olive View-UCLA Medical Center: medical records delinquent for greater than thirty (30) days when the chart is available, will be reported to the Program Director for action.
Failure to complete medical records will result in the following actions, in sequence:
- Verbal notification and opportunity to complete the records within 72 hours.
- Formal letter of reprimand for failure to complete medical records to be placed in the trainee's file.
- Suspension of clinical privileges, including admitting, consulting, and surgical privileges. Such suspension will result in removal from the clinical rotation, and assignment of leave without pay status until such time as the Program Director is notified that the delinquency has been removed. No credit for residency training will be given for the period of suspension. In the event that your clinical privileges are suspended by the date named in your written notification, the following actions are mandated by UCLA Medical Staff ByLaws, and California State Law. Notification of your specialty Certification Board for failure to comply with Medical Center and Medical Staff Rules and Regulations and notification of the Medical Board of California, which may jeopardize the ability to obtain or maintain medical licensure in the State of California.
Three (3) episodes of suspension of clinical privileges may result in dismissal from the program.