Hawaii Residency Programs Resident Duty Hours Policy*
Duty hours are defined as all clinical and academic activities related to the residency program, ie., patient care (both inpatient and outpatient), administrative duties related to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled academic activities such as conferences. Duty hours do not include reading and preparation time spent away from the duty site. Duty hours are limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities. HRP does not permit any exceptions to the 80 hour limit. This 80 hour limit will be monitored by HRP to ensure that it is observed. Residents will 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. Adequate time for rest and personal activities will be provided. This should consist of a 10 hour time period provided between all daily duty periods and after in-house call. All moonlighting activities, if authorized pursuant to the procedures listed below, will be counted toward the 80 hour limit.

On Call Activities
The objective of on-call activities is to provide residents with continuity of patient care experiences throughout a 24-hour period.
In-house call is defined as those duty hours beyond the normal work day when residents are required to be immediately available in the assigned institution.
  • In-house call must occur no more frequently than every third night, averaged over a four-week period.
  • Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Residents may remain on duty for up to 6 additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics and maintain continuity of medical and surgical care (unless further limited by the relevant Program Requirements).
  • No new patients may be accepted after 24 continuous hours on duty. new patient is defined as any patient for whom the resident has not previously provided care (unless otherwise defined in the relevant Program Requirements).
  • At-home call (pager call) is defined as call taken from outside the assigned institution.
    1. The frequency of at-home call is not subject to the every third night limitation. However, at-home call must not be so frequent as to preclude rest and reasonable personal time for each resident. Residents taking at-home call must be provided with 1 day in 7 completely free from all educational and clinical responsibilities, averaged over a 4-week period.
    2. When residents are called into the hospital from home, the hours residents spend in-house are counted toward the 80-hour limit.
    3. The demands of at-home call will be monitored and schedule adjustments will be made as necessary to mitigate excessive service demands and/or fatigue.

*Adopted from the ACGME requirements effective 7/1/03
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