a) At-Home Call (or pager call) is call taken from outside the assigned institution;
b) In-House Call is comprised of Duty Hours beyond the normal workday, when Residents are required to be immediately available in the assigned institution.

1. Duty Hour Limitations.

a. Assignment of Residents shall be limited to no more than 12 consecutive Duty Hours per on-duty assignment in the Emergency Medicine Department.
b. The scheduled workweek shall not exceed an average of 80 Duty Hours per week, averaged over a 4-week period, inclusive of all In-House Call.
c. Continuous on-site duty, including In-House Call, must not exceed 24 consecutive Duty Hours. Residents may remain on duty for up to 3 additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of medical and surgical care, as defined in Specialty and Subspecialty Program Requirements.
d. Adequate time for rest and personal activities must be provided to Residents. In determining limits on Resident Duty Hours, as set forth in subparagraphs (a) and (b) of this paragraph, the Director of Residency Training ("Director") shall require that scheduled on-duty assignments be separated by not less than 8 non-Duty Hours. Residents shall have at least one 24-hour period free from all clinical, educational, and administrative activities per week.

2. Prohibition. Residents who have worked the maximum number of Duty Hours permitted in subparagraphs (a) through (d) of this paragraph shall be prohibited from working additional hours as physicians providing professional patient care services.

3. Exceptions. The Graduate Medical Education Committee will neither entertain nor endorse requests for exceptions to this policy

1. Supervision of Residents.

a. All patient care must be supervised by qualified faculty. The Director must ensure, direct, and document adequate supervision of Residents at all times. Residents must be provided with rapid, reliable systems for communicating with supervising faculty.
b. Faculty schedules must be structured to provide Residents with continuous supervision and consultation.
c. Faculty and Residents must be educated to recognize the signs of fatigue and adopt and apply policies to prevent and counteract the potential negative effects.

2. On-Call Activities. The objective of on-call activities is to provide Residents with continuity of patient care experiences throughout a 24-hour period.

a. In-House Call must occur no more frequently than every third night, averaged over a 4-week period.
b. No new patients, as defined in Specialty and Subspecialty Program Requirements, may be accepted after 24 hours of continuous duty.
c. 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.
d. When Residents are called into the hospital from home, the hours the Residents spend in-house are counted toward the 80-Duty Hour limit, as established under Section III.A.1.b., Policy, of this document.
e. The Director must monitor the demands of At-Home Call in his/her program and make scheduling adjustments as necessary to mitigate excessive service demands and/or fatigue on his/her Residents.

3. Oversight.

a. Each program must have written procedures consistent with this Duty Hours Policy for Residents. This policy and the written department procedures must be distributed to Residents and faculty. Monitoring of Duty Hours is required with frequency sufficient to ensure compliance and an appropriate balance between education and service.
b. Back-up support systems must be provided when patient care responsibilities are unusually difficult or prolonged, or if unexpected circumstances create Resident fatigue sufficient to jeopardize patient care.