DOH and IPRO Release Resource Documents
The NYS Department of Health (DOH) and its contracted survey organization, IPRO, have prepared a comprehensive resource document for use by hospital administrators and residency program directors to assist compliance efforts with the State regulations on resident working hours and conditions. IPRO also recently prepared a document outlining the relationship between the State regulations and the new Accreditation Council for Graduate Medical Education (ACGME) duty hour requirements, which went into effect July 1, 2003.

Hospital Compliance Resource Document
DOH and IPRO prepared a comprehensive resource document that reviews the many issues and questions that DOH and IPRO staff have heard over the past several years as the surveys have been conducted. DOH shared a draft version of this document with Greater New York Hospital Association (GNYHA), which then provided extensive comments, with the goal of clarifying key areas and ensuring maximum usability of the document by a variety of interested parties, including hospital administrators, compliance officers, GME administrators, residency program directors, and residency trainees.

The first section of the document briefly reviews several key points regarding the regulations, the survey process, and some issues that have been raised (for example, privacy of patient-specific information) in the context of the surveys. The second section is in a question-and-answer format and covers specific aspects of the regulations, including the 24-consecutive-hour limitation, the use of transition time, moonlighting policies, and the surgical exemption. The document also describes how DOH assesses compliance with these components of the regulations. Many of the questions in the document have been raised at the numerous DOH-IPRO briefing sessions and meetings held by GNYHA over the past several years.

New York State-ACGME Comparison Guidelines
IPRO has also prepared a chart that compares the main areas of the State regulations with the ACGME requirements. As GNYHA has noted, the areas of difference that may have a practical impact on compliance efforts among New York hospitals include the allowances for transition time after night call and, in particular, the minimum time standard for required nonworking periods.

The ACGME allows up to six hours for transition time, although the State still has a three-hour maximum limit. In the case of those New York hospitals that choose to utilize the State's surgical exemption, which allows for an extended work period for surgical programs under certain conditions, the ACGME limitation of six additional hours following a 24-consecutive-hour on-call period would mean that a maximum of 30 consecutive hours would be allowable to comply with both the State and the ACGME requirements. For non-surgical programs and surgical programs not using the State's surgical exclusion provision, the State limit of 27 hours (24 consecutive hours, plus up to three hours of transition time) would apply.

Following vigorous advocacy by GNYHA and others regarding the ACGME's proposed strict nonworking period minimum requirement of 10 hours, the ACGME modified the requirement in part to indicate that the goal is adequate rest time and teaching institutions should try to accommodate 10-hour nonworking periods. In light of that modification, a GME committee and residency program that believes it is only able to provide the State-mandated eight-hour nonworking period would be expected to document the reasons for needing that accommodation and, in particular, should note the educational reasons for requesting the accommodation.

Copies of the documents are available from Tim Johnson of GNYHA at tjohnson@gnyha.org or (212) 506-5420.

Unannounced Surveys
In response to a letter sent to DOH Commissioner Antonia C. Novella, M.D., M.P.H., Dr.P.H., DOH has indicated an unwillingness to alter the current survey protocol. Although GNYHA appreciates that DOH has reviewed the issue with IPRO staff and has improved the process since the start of the IPRO contract, GNYHA continues to hear from its members about the disruption that occurs as a result of these unannounced surveys, and particular decisions about the timing of the visits. GNYHA will continue to reiterate that, because the majority of these on-site surveys are not complaint investigations but annual compliance reviews, this policy should be modified.