title: An ACGME Duty Hour Compliant 3-Person Night Float System for Neurological Surgery Residency Programs.
abstract: BACKGROUND
  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.
  
  
  METHODS
  In response, Oregon Health & Science University's (OHSU) neurological surgery residency instituted a 3-person night float system.
  
  
  METHODS
  We analyzed work hour records and operative experience for 1 year before and after night float implementation in a model that shortened a combined introductory research and basic clinical neurosciences rotation from 12 to 6 months. We analyzed residents' perception of the system using a confidential survey. The ACGME 2011 work hour standards were applied to both time periods.
  
  
  RESULTS
  AFTER NIGHT FLOAT IMPLEMENTATION, THE NUMBER OF DUTY HOUR VIOLATIONS WAS REDUCED: 28-hour shift (11 versus 235), 8 hours off between shifts (2 versus 20), 80 hours per week (0 versus 17), and total violations (23 versus 275). Violations increased only for the less than 4 days 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.
  
  
  CONCLUSIONS
  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.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Ragel
authors.forename: Mark
authors.initials: M
authors.lastname: Piedra
authors.forename: Paul
authors.initials: P
authors.lastname: Klimo
authors.forename: Kim J
authors.initials: KJ
authors.lastname: Burchiel
authors.forename: Heidi
authors.initials: H
authors.lastname: Waldo
authors.forename: Shirley
authors.initials: S
authors.lastname: McCartney
authors.forename: Nathan R
authors.initials: NR
authors.lastname: Selden