Keeping Duty Hours in Hand: Exploiting Texting to Ensure Compliance

To develop and implement a proactive, real-time duty hour monitoring system to improve compliance with Accreditation Council for Graduate Medical Education (ACGME) regulations. The primary goal was to obtain accurate, real-time data on resident work hours and facilitate timely administrative interventions.

This project was a prospective educational quality improvement initiative utilizing an automated text-message-based reporting system. Residents received daily automated text prompts to reply with their duty hours worked the preceding day. Resident text responses were recorded in a shared scheduling calendar system accessible to program leadership that included call assignments and scheduled time off. Logged hours were then reviewed to confirm duty hour regulation compliance, determine appropriateness of requested schedule changes, and intervene to prevent potential violations. Residents were also queried monthly by text to confirm compliance with duty hours requirements and any discrepancies about compliance were reviewed in detail to ensure the resident and program director were aware of the data and circumstances.

The project was conducted at Jefferson Abington Hospital, a university affiliated academic medical center with an ACGME-accredited 31 resident general surgery residency.

All general surgery residents participated in the initiative.

Prior to implementation, web-based duty hour reporting through New Innovations (NI) was inconsistent, very delayed and inaccurate. While only 14 violations were reported by the program in NI in the year preceding implementation, internal and ACGME surveys indicated widespread noncompliance leading to 3 ACGME duty hour citations. Following implementation of the real-time tracking system, improved real time duty hour logging and resultant improved data accuracy enabled timely administrative actions including call adjustments and schedule modifications. Violations detected early in the academic year led to schedule adaptations to prevent future violations as well as analysis of schedule change requests to prevent violations. Nine violations were recorded for the implementation academic year, and most were reported by the program director to the unaware resident. High immediate response rates to the text queries, utilization of real time data to make scheduling decisions/adaptations and high resident confidence in the validity of the data dramatically improved both compliance and the survey responses allowing resolution of all 3 duty hour citations.

A proactive, real time monitoring system using a familiar and available communication mode significantly improved the accuracy and timeliness of duty hour reporting compared to traditional web-based reporting methods. By leveraging an automated, mobile based text approach, this system not only increased resident engagement and accuracy but also provided leadership with actionable data to ensure compliance with ACGME work-hour regulations. This model can be adapted by other programs to enhance duty hour oversight and resident wellbeing.