At Swedish Family Medicine-First Hill Residency we are committed to providing residents with a sound academic and clinical education while prioritizing patient safety and resident well-being. Didactic and clinic education has priority in the allotment of residents’ time and focus. Every resident and faculty has a personal role to play in assuring the safety and welfare of our patients, which includes assuring his or her fitness for duty and recognizing fatigue in themselves and others. This requires honest and accurate reporting of work hours, and recognizing that, under certain circumstances, the best interests of the patient may be served by transitioning that patient’s care to another qualified provider.
Work Hours
Residents will be assigned on-call, night float, and weekend duties on a regular basis, as well as defined off hours. These hours recognize that faculty and residents collectively have responsibility for the safety and welfare of patients. The schedule is designed to minimize transitions in care, and effective handoffs are an important part of the clinical responsibilities of residents.
Clinical and educational work hours include all clinical and academic activities related to the residency program. This includes inpatient and outpatient clinical care, in-house call, night float, transfer of patient care, and administrative activities related to patient care, such as completing clinical documentation or reviewing records related to the care of a patient. This also includes scheduled activities, such as conferences. Work hours do not include reading and preparation time for an upcoming clinical activity.
Maximum Hours of Clinical and Educational Work per Week
Clinical and educational work hours must be limited to no more than 80 hours per week, averaged over a four-week period, inclusive of all in-house clinical and educational activities, as well as clinical work done from home.
Maximum Clinical Work and Education Period Length
Clinical and educational work periods for residents must not exceed 24 hours of continuous scheduled clinical assignments. Strategic napping, particularly after 16 hours of continuous duty and after 10 pm in a 24 hour shift, is strongly suggested. Residents may stay up to four additional hours of time 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.
In-House Night Float
Night float must occur within the context of the 80-hour and one day-off-in-seven requirements. Night float experiences must not exceed 50 percent of a resident’s inpatient experiences.
Mandatory Time Free of Clinical Work and Education
Residents should have eight hours off between scheduled clinical work and education periods.
Residents must have at least 14 hours free of clinical work and education after 24 hours of in-house call.
In rare circumstances, after handing off all other responsibilities, a resident, on their own initiative, may elect to remain or return to the clinical site in the following circumstances: (1) to continue to provide care to a single severely ill or unstable patient; (2) humanistic attention to the needs of a patient or family; or, (3) to attend unique educational events. These additional hours of care or education will be counted toward the 80-hour weekly limit and the one day in seven.
Residents must be scheduled for a minimum of one day in seven free of clinical work and required education (when averaged over four weeks). One day is defined as a continuous 24-hour period free from all clinical, educational, and administrative activities. Residents should strive to allow this time to be protected for activities unrelated to clinical work.
Continuity Obstetrical Deliveries
A senior resident’s continuity obstetrical delivery might inspire a resident to choose to remain beyond scheduled work hours to care for that single patient. The unpredictable onset and duration of labor and delivery present a unique challenge to work hours. While we understand that continuity of care is important to providers and patients, there may be times when the resident cannot remain for the delivery.
If the senior resident is too fatigued to safely care for the patient, the patient should be cared for by the Family Medicine Service or appropriate OB coverage.
If the senior resident has already completed 24 hours of work, s/he may remain for delivery, if resident-initiated and delivery is anticipated within 4 hours.
If the senior resident is currently on night float or another rotation where more than one at-risk resident will have to be called in to safely cover scheduled responsibilities, s/he may need to leave in time to have eight hours free before returning to work.
Resident Illness or Absence
In the event of resident illness or absence, coverage will be provided by another resident using a prebuilt at-risk system. If other residents are required to take additional calls, the chief residents will insure that those who are tasked with additional call duties will not exceed the work hours guidelines. In the event no resident is available to take call, the attending physician will work with the chiefs to identify an adequate coverage plan.
Reporting of Clinical Work and Education
Residents are personally responsible for logging work hours into New Innovations, at a minimum once a block, though they may track as frequently as daily or weekly.
Any system or scheduling problems should be reported to the chief residents and the Program Director.
Residents are required to notify the appropriate chief and/or a faculty physician if their hours are approaching a potential violation so that their schedule can be adjusted as needed.
The Program Director and Program Administrator review all work hour violations when they are submitted electronically. This information is used to track both individual resident and program-wide episodes of work hours violations.
Work Hours are reported to the hospital Graduate Medical Education committee and also reviewed in the Swedish Resident and Fellowship Manual, available on the intranet.
Updated 8/20/18