Introduction

Rules regarding the upper limits on the number of patients residents may admit and work hours in any given time period are guidelines. If the welfare of patients requires physicians-in-training to exceed an arbitrary limit of new admissions or hours worked, then flexibility in the interpretation of the rules is required. Only exceptional circumstances set the stage for exceptions to the following rules.

First Year Residents

First year residents should admit no more than five new patients per admitting period and no more than eight new patients in any 48-hour period. If these numbers are exceeded, it is appropriate for the supervising resident to admit patients and assume primary patient care responsibility for the excess number of admissions. Such patients, however, will be assigned on the next day to a first year resident, who will be expected to perform an admitting quality work-up.

Residents will spend no more than 80 hours per week in patient care duties and will be on call no more often than every third night. Regardless of the rotation, residents will have one full day out of seven free of patient care duties.

During emergency medicine rotations, continuous duty will not exceed twelve hours and duty periods will be separated by at least eight hours.

Supervising Residents

Supervising residents are responsible for the care of all patients on their services. Unless they are admitting patients in exceptional instances as described above, their work-ups are appropriately more focused than those of PGY-1s. At a minimum, their notes should identify a chief complaint with an elucidation of the history of present illness, relevant past history, and medications. The physical exam should be confined to the patient's major problems, with pertinent negatives as appropriate. An explicit assessment and plan for each of the patient's major active problems is also required. For those patients not initially admitted by a PGY-1 (see above), a more complete admission note is required.

Residents will spend no more than 80 hours per week in patient care duties and will be on call no more often than every third night. Regardless of the rotation, residents will have one full 24-hour period out of seven free of patient care duties.

During emergency medicine rotations, continuous duty will not exceed twelve hours and duty periods will be separated by at least eight hours.

 

Revised 4/28/04, 6/28/04