An ACGME Duty Hour Compliant 3-Person Night Float System for Neurological Surgery Residency Programs.

Abstract

In 2003, the Accreditation Council for Graduate Medical Education (ACGME) instituted the 24+6-hour work schedule and 80-hour workweek, and in 2011, it enhanced work hour and supervision standards. In response, Oregon Health & Science University's (OHSU) neurological surgery residency instituted a 3-person night float system. We analyzed work hour records and operative experience for 1year before and after night float implementation in a model that shortened a combined introductory research and basic clinical neurosciences rotation from 12 to 6months. We analyzed residents' perception of the system using a confidential survey. The ACGME 2011 work hour standards were applied to both time periods. AFTER NIGHT FLOAT IMPLEMENTATION, THE NUMBER OF DUTY HOUR VIOLATIONS WAS REDUCED: 28-hour shift (11 versus 235), 8hours off between shifts (2 versus 20), 80hours per week (0 versus 17), and total violations (23 versus 275). Violations increased only for the less than 4days off per 4-week interval rule (10 versus 3). No meaningful difference was seen in the number of operative cases performed per year at any postgraduate year (PGY) training level: PGY-2 (336 versus 351), PGY-3 (394 versus 354), PGY-4 (803 versus 802), PGY-5 (1075 versus 1040), PGY-7 (947 versus 913), and total (3555 versus 3460). Residents rated the new system favorably. To meet 2011 ACGME duty hour standards, the OHSU neurological surgery residency instituted a 3-person night float system. A nearly complete elimination of work hour violations did not affect overall resident operative experience.