Work Hours Assessment and Monitoring Initiative (WHAMI) under resident direction: A strategy for working within limitations

Michael Goldstein, Benjamin Samstein, Akuo Ude, Warren D. Widmann, Mark A. Hardy

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Purpose: A review of surgical residents' duty-hours prompted a Work Hours Assessment and Monitoring Initiative (WHAMI) that preemptively limits residents from violating "duty-hours rules." Methods: Work hours data for the Department of Surgery were reviewed over 8-months at New York Presbyterian Hospital-Columbia Campus. This ongoing review is performed by a work-hours monitoring team, which supervises residents' hours for the initial 5-days of each week. As residents approach work-hours limits for the week, they are dismissed from duty for appropriate time periods in the remaining 2 days of the week. Results: The work-hours data entry compliance for 52 residents wa s increased from 93% to 99% after creation of the WHAMI. Before the new system, a mean of 9.5 residents per month (19%) worked an average of 7.3 ± 6.4 hours over the 80-hour limit. Averaged monthly compliance with the 80-hour work limit was increased to 98% with introduction of the WHAMI. A review of on-call duty hours revealed a mean of 7 (14%) residents per month who worked an average of 2.4 hours beyond 24-hour call limitations including "sign-out" time imposed by the ACGME. New monitoring procedures have improved compliance to 100% with 24-hour call limitations imposed by the ACGME. Compliance with the more stringent New York State (NYS) guidelines has approached 94% with noncompliant residents extending on-call hours by an average of 1.5 hours over the 24-hour limitations, most on "off General Surgery" rotations or out-of-state rotations. Review of mandatory rest periods contributed to an increase in mean "time off" between work periods, thereby increasing compliance with ACGME guidelines and NYS regulations from 75% to 88%, and 90% to 98%, respectively. Residents reporting less than 10 hours rest reported increased "time off" from 6.2 ± 2.0 to 7.9 ± 1.3 hours (p < 0.001). Conclusions: Internal review of surgical resident 's duty-hours at a large university hospital revealed that despite strict scheduling and the requirement of mandatory duty-hours entry, achieving the goals of meeting the duty-hours requirements and of ongoing data entry required the creation of a resident enforced, real-time Work Hours Assessment and Monitoring Initiative.

Original languageEnglish (US)
Pages (from-to)132-137
Number of pages6
JournalCurrent Surgery
Volume62
Issue number1
DOIs
StatePublished - Jan 2005
Externally publishedYes

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resident
monitoring
surgery
Direction compound
Guidelines
Compliance
scheduling
time
regulation
university

Keywords

  • Limitations
  • Monitoring
  • Resident
  • Work-hours

ASJC Scopus subject areas

  • Surgery

Cite this

Work Hours Assessment and Monitoring Initiative (WHAMI) under resident direction : A strategy for working within limitations. / Goldstein, Michael; Samstein, Benjamin; Ude, Akuo; Widmann, Warren D.; Hardy, Mark A.

In: Current Surgery, Vol. 62, No. 1, 01.2005, p. 132-137.

Research output: Contribution to journalArticle

Goldstein, Michael ; Samstein, Benjamin ; Ude, Akuo ; Widmann, Warren D. ; Hardy, Mark A. / Work Hours Assessment and Monitoring Initiative (WHAMI) under resident direction : A strategy for working within limitations. In: Current Surgery. 2005 ; Vol. 62, No. 1. pp. 132-137.
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