ACGME will limit residents' work hours by July 2003. (80-Hour-Week Maximum).

Responding to concerns that resident sleep deprivation poses a risk to patient safety the Accreditation Council for Graduate Medical Education has imposed limits on resident duty hours.

Institutions must place a higher value on resident education and patient care than on meeting service needs, the Accreditation Council for Graduate Medical Education (ACGME) says in its new standards, which will go into effect on July 1, 2003. The council oversees 100,000 physicians in about 7,800 residency programs nationwide.

The new standards include a limit of 80 duty hours per week, with a minimum of 10 hours of time off between shifts. At least one 24-hour day each week should be free of patient care duties. Residents must not be on call more often than every third night. Continuous time on duty is limited to 24 hours. Limitations on moonlighting are strengthened to control the total number of work hours.

Faculty and program directors are responsible for noting if residents are fatigued under the new code. Institutions are responsible for educating faculty on sleep issues and for giving residents backup support if they are engaged in routine activities or patient care for prolonged periods.

Concern about residents' schedules has become more pronounced as the pressures of shorter hospital stays, more medical procedures to manage, and less support have combined to make it more difficult to balance education and patient care, the ACGME said in a statement. Calls to ACGME for comment were not returned by press time.

"Residents have more to do, in less time, with less support than ever before," Dr. David Leach, ACGME's executive director, said in a statement.

All U.S. resident training programs are required to comply; those that do not comply will lose their ACGME accreditation. This is tantamount to a "death sentence" for residency programs and would result in the loss of their Medicare funding for graduate medical education, according to the ACGME.