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Those Adorable Work Hour Reports

October 27, 2019
by Mark David Siegel

Hi everyone,

Okay, work hour reports aren’t really adorable, but you fell for my click bait and now you’re a captive audience...

I heard a rumor that some of you were worried we’d think less of you for reporting work hour violations. Not true.

First, we’d never think less of you for anything, especially for working hard. Yes, when some of you report duty hour violations, we may learn that you need help with efficiency, but that’s no big deal. We can help. I was one of the least efficient interns ever, and I wish someone had helped me.

Other work hour violations fall into three categories: artifact, emergencies, and systems problems.

Work hour artifacts happen because MedHub can’t tell true violations from normal scheduling variations. Some weeks you won’t have a day off; the ACGME is okay with that if you have two days off in an adjoining week. It's also okay—though not ideal—to work more than 80 hours one week as long as you average fewer than 80 for the rotation. Just tell us if the schedule needs fixing.

Sometimes you will stay late for emergencies. No one, including the ACGME, expects you to leave patients during emergencies if you truly have to stay. If you are the only one who knows the patient, you may stay to ensure a safe transition; but if you need to stay because staffing is inadequate, we need to know.

The most helpful reports identify systems problems, like occasional scheduling errors, staffing shortages, and workflow problems. As the hospital census grows, and as patients become sicker and more complex, we may learn that old systems are failing.

So send us your honest, descriptive work hour reports. We don’t need novels, but we do need enough information to take action. Minimalist descriptions like “the schedule” or “busy rotation” don’t cut it, but comments like these help a lot: “I’ll have two days the next week,” “a patient was crashing,” “the sign-out system needs to be fixed,” or “there’s too much work to do to leave on time.”

Your comments help us know what’s working and what’s not. With your help, we can tweak schedules and admitting structures. More importantly, your reports give us the data we need to improve staffing. As an example, your reports persuaded the hospital to hire APPs to join the CICU team. They will be a huge help.

So keep those adorable work hour reports coming. Your input will help us reach the goal of zero duty hour violations and will contribute enormously to patient safety and resident wellbeing.

Stay dry on this rainy Sunday!


Submitted by Mark David Siegel on October 27, 2019