The Accreditation Council for Graduate Medical Education resident duty hour new standards: History, changes, and impact on staffing of intensive care units Journal Article


Authors: Pastores, S. M.; O'Connor, M. F.; Kleinpell, R. M.; Napolitano, L.; Ward, N.; Bailey, H.; Mollenkopf, F. P.; Coopersmith, C. M.
Article Title: The Accreditation Council for Graduate Medical Education resident duty hour new standards: History, changes, and impact on staffing of intensive care units
Abstract: Objectives: The Accreditation Council for Graduate Medical Education recently released new standards for supervision and duty hours for residency programs. These new standards, which will affect over 100,000 residents, take effect in July 2011. In response to these new guidelines, the Society of Critical Care Medicine convened a task force to develop a white paper on the impact of changes in resident duty hours on the critical care workforce and staffing of intensive care units. PARTICIPANTS:: A multidisciplinary group of professionals with expertise in critical care education and clinical practice. DATA SOURCES AND SYNTHESIS:: Relevant medical literature was accessed through a systematic MEDLINE search and by requesting references from all task force members. Material published by the Accreditation Council for Graduate Medical Education and other specialty organizations was also reviewed. Collaboratively and iteratively, the task force corresponded by electronic mail and held several conference calls to finalize this report. MAIN Results: The new rules mandate that all first-year residents work no more than 16 hrs continuously, preserving the 80-hr limit on the resident workweek and 10-hr period between duty periods. More senior trainees may work a maximum of 24 hrs continuously, with an additional 4 hrs permitted for handoffs. Strategic napping is strongly suggested for trainees working longer shifts. Conclusions: Compliance with the new Accreditation Council for Graduate Medical Education duty-hour standards will compel workflow restructuring in intensive care units, which depend on residents to provide a substantial portion of care. Potential solutions include expanded utilization of nurse practitioners and physician assistants, telemedicine, offering critical care training positions to emergency medicine residents, and partnerships with hospitalists. Additional research will be necessary to evaluate the impact of the new standards on patient safety, continuity of care, resident learning, and staffing in the intensive care unit. © 2011 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.
Keywords: review; clinical practice; quality of life; intensive care unit; intensive care units; education; internship and residency; systematic review; patient safety; medline; accreditation; critical care; continuity of patient care; residency education; work schedule; staffing; nurse practitioners; sleep; telemedicine; e-mail; personnel staffing and scheduling; safety management; accreditation council for graduate medical education; intensive care unit workforce; resident duty hours; supervision; physician assistants
Journal Title: Critical Care Medicine
Volume: 39
Issue: 11
ISSN: 0090-3493
Publisher: Lippincott Williams & Wilkins  
Date Published: 2011-11-01
Start Page: 2540
End Page: 2549
Language: English
DOI: 10.1097/CCM.0b013e318225776f
PROVIDER: scopus
PUBMED: 21705890
DOI/URL:
Notes: --- - "Cited By (since 1996): 1" - "Export Date: 9 December 2011" - "CODEN: CCMDC" - "Source: Scopus"
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  1. Stephen Pastores
    180 Pastores