title: The Accreditation Council for Graduate Medical Education resident duty hour new standards: history, changes, and impact on staffing of intensive care units.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  A multidisciplinary group of professionals with expertise in critical care education and clinical practice.
  
  
  METHODS
  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.
  
  
  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.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA. pastores@mskcc.org
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Pastores
authors.forename: Michael F
authors.initials: MF
authors.lastname: O'Connor
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Kleinpell
authors.forename: Lena
authors.initials: L
authors.lastname: Napolitano
authors.forename: Nicholas
authors.initials: N
authors.lastname: Ward
authors.forename: Heatherlee
authors.initials: H
authors.lastname: Bailey
authors.forename: Fred P
authors.initials: FP
authors.lastname: Mollenkopf
authors.forename: Craig M
authors.initials: CM
authors.lastname: Coopersmith
mesh_terms: D000068:Accreditation / Q000592:standards*; D003266:Continuity of Patient Care / Q000458:organization & administration; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration* / Q000592:standards; D007396:Internship and Residency / Q000458:organization & administration* / Q000592:standards; D009722:Nurse Practitioners / Q000458:organization & administration; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration* / Q000592:standards; D010823:Physician Assistants / Q000458:organization & administration; D011788:Quality of Life; D017751:Safety Management / Q000458:organization & administration; D017216:Telemedicine / Q000458:organization & administration