III.E.7 At-Home Call

Time spent on patient care activities while on at-home call must count toward the House Officer's 80-hour maximum weekly limit. The frequency of at-home call is not subject to the every-third night limitation but must satisfy the requirement for one day in seven free of clinical work and education, when averaged over four weeks.
At-home call must not be so frequent or taxing as to preclude rest or reasonable personal time for each resident.
House Officers are permitted to return to the hospital while on at-home call to provide direct care for new or established patients. Each episode of this type of care, while it must be included in the 80-hour weekly maximum, will not initiate a new "off-duty period".

• House Officers are required to log all work hours in New Innovations. Failing to log work hours or logging erroneous work hours may result in disciplinary action.

The School of Medicine and individual Programs are required to monitor and document compliance with clinical education and work hour requirements for all House Officers. This policy applies to every site where House Officers rotate.
To ensure compliance, the institution has implemented the following policies and procedures:

1. Each program director must sign a statement attesting to compliance with the requirements at all sites.
2. Each program will develop their own written clinical and educational work hour policy in compliance with the ACGME and LSUHSC Institutional policy. This policy will be distributed to all trainees and faculty with a copy provided to the GME Office. The policy must specifically address how compliance will be monitored and what actions will be taken to remedy problems. Yearly changes or revisions to policies must be forwarded to the GME Office.
3. Programs must monitor House Officers for fatigue. The Sponsoring Institution provides resources to educate faculty and House Officers about sleep deprivation and fatigue.
4. The Sponsoring Institution will ask each participating site to advise (where legally permissible) it of incidents or trends that suggest fatigue is an issue.
5. If the Program has instituted a method to monitor for individual House Officer clinical and educational work hour compliance (e.g. work hour logs) it will regularly share this data with the Sponsoring Institution.
6. In addition to other monitoring, the Sponsoring Institution encourages programs to add questions regarding clinical and educational work requirements to their monthly rotation evaluations.
7. The Sponsoring Institution will advise House Officers that the Ombud is available to field anonymous questions or complaints about clinical and educational work hours
8. The House Officer Agreement of Appointment/Contract includes a reference to clinical and educational work hours policy and an agreement to participate in institutional monitoring of clinical and educational work hours
9. Special Focused Reviews may include detailed review of clinical and educational work hours
10. An annual anonymous web-based questionnaire will be administered to House Officers regarding clinical and educational work hours by the GME Office
11. The GME Office will randomly audit programs for clinical and educational work hour compliance
12. Program-specific data will be presented annually in the PEC meeting minutes submitted to the GME Office
13. Violations of clinical and educational work hour requirements by participating sites may result in removal of House Officers from that site
14. Programs with constant violations will be regularly monitored by GMEC and may be subject to closure
15. Moonlighting must be approved in writing and strictly monitored to assure House Officer fatigue does not become a problem
16. House Officers may anonymously report violations to the Clinical and Educational Work Hours Hotline at (504) 599-1161.