V. Duty Hours and Fatigue Management

Duty Hour Policy

The David Geffen School of Medicine at UCLA 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 in-house call activities.

Duty hours do not include reading and preparation time spent away from the hospital.

Residents must be provided with one day in seven free from all educational and clinical responsibilities, averaged over a four-week period. One day is defined as one continuous 24-hour period free from all clinical, educational, and administrative activities. Residents must also be provided at least eight hours between duty assignment periods to obtain adequate rest.

PGY1 residents may not exceed 16 hours during their duty periods.

PGY2-7 residents: In-house call must not exceed 24 consecutive hours. Resident may remain on duty for up to four additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of medical and surgical care. No new patients may be accepted after 24 hours of continuous duty.

Residents are required to report and log all duty hours on MedHub. Resident must log in at least once every week. The Program Administrator runs reports on a weekly basis to review each resident's reported duty hours to ensure compliance and address potential violations.

Duty hours are clinical and academic activities related to the residency program.  Duty hours do not include reading and time spent away from the training program. Resident duty hours regulations apply to all clinical activity, including moonlighting.

The Program Director and UCLA Chief Resident reviews the MedHub work hour report weekly to review for accuracy and to address compliance and fatigue concerns.  The Chief Residents are responsible for determining which residents have maximized their work hours and are in jeopardy of fatigue.  The Chief Residents must adjust the coverage schedules to compensate for residents required to be away from service. The Site Directors provide an additional level of oversight.

The Program Director or his designee reviews the aggregate work hour reports quarterly and addresses any areas of non-compliance either during the monthly group meeting with the residents or individual meetings as needed.

The Program Director provides an annual written report to the UCLA GMEC.

Fatigue Management

All residents are required to undergo annual Fatigue Management training.

Excessive fatigue, risking harm to patient or self, should be avoided and mitigated using what was learned on the Fatigue Management training. The resident is required to notify the immediate supervisor if excessive fatigue is present. The resident is encouraged to reach the Residency Program Director, the Department Chair, or Resident Ombudsman at any time if the immediate supervisor does not provide an opportunity for rest.