BWH Prepares for New ACGME Standards
The Accreditation Council for Graduate Medical Education (ACGME) recently approved new work hour standards for residents and fellows—including changes that will affect far more than their work schedules.
“The ACGME, for a variety of reasons, including increasing public concerns about patient safety, took a hard look at the rules as they stood and revised the program requirements,” said John Co, MD, MPH, director of graduate medical education for Partners HealthCare and BWH’s institutional officer to the ACGME.
Co notes that the most significant change in the new standards, which go into effect July 1, is that PGY-1 residents will no longer be allowed to do a 24-hour duty period. Whereas the current duty hour standards do not make a distinction between training levels, under the new rules, PGY-1 residents are no longer permitted to work more than 16 consecutive hours, and residents PGY-2 and above are limited to 24 hours.
“This change has a lot of training programs and institutions concerned,” Co said. “Even though much of the direct effect is on the residency programs, residents are critical members of the care team. While residents cannot stay in the hospital as long, the patient care needs don’t disappear. That work still has to be accounted for. Also, it’s likely that this change will result in more handoffs between providers, which increases the risk for errors if discontinuity of care is associated with any lapses in communication.”
Co notes that the new standards will also impact the strategic planning efforts currently underway at Partners HealthCare and BW/F.
“In many ways, it’s timely and beneficial that the new regulations will take effect at the same time that Partners is undergoing its strategic planning process. Both BW/F and Partners are looking at care redesign, including inpatient services,” said Co, who is a member of the Partners Inpatient Care Units Team. “In any of our care redesign efforts, the rules changes need to be considered, to assure that patients receive the necessary care, and that members of the care team understand their roles and duties. It’s very possible that these ACGME rules could affect the responsibilities of others on the team.”
Another new standard changes the number of hours allowed for transition time. Residents are currently allowed to stay at the hospital for an additional six hours to provide transition and care; beginning July 1, PGY-2 residents and above will only be allowed to stay for four hours.
“Though the number of hours for transition time will be reduced, the rules state that in unusual circumstances, the trainee can stay longer to care for a single patient that is severely ill, participate in an unusual educational opportunity, or for humanistic reasons,” Co said.
While the changes will require adjustments, ultimately, the hope is that patients and trainees will benefit from them.
“The rules were revised with the goal of optimizing patient care quality. The hope is that less fatigued and properly supervised residents will make fewer errors and provide better care,” said Co. “We should recognize though that residents and fellows are still learners in the early stages of their medical career. In addition to providing outstanding care, the institution and training programs have an added responsibility to assure that by the time the trainee completes the program, he or she can practice competently and independently to assure patient health and safety in the long run.”
To view the complete list of new standards, visit http://acgme-2010standards.org