Best Practices

While the dangers of having resident physicians work long hours are clear, moving towards a schedule that reduces resident work hours to safer levels can prove challenging in many US hospitals where long hours have long been the norm. Any scheduling change must demonstrate its ability to maintain, if not improve, both the quality of patient care and the value of educational training provided in the residency program. Below are some “Best Practice” resources on how residency programs have been able to do just that – reduce work hours while enhancing patient care and resident education. It is Hours Watch’s hope that by sharing these best practices, other residency programs might be aided in their own efforts to pursue similar goals.


Existing 16-hour systems 

3 Case Studies: Reducing Resident On-Call Shifts to ≤ 16 Hours:
How did programs at Seattle’s Virginia Mason Medical Center, Akron’s Summa Health System and New York’s St. Luke’s-Roosevelt reduce their maximum on call shifts to 16 hours or less? 

Ob-Gyn Chair Thinks ‘Outside the Box’ in Brooklyn, NY
Saying good-bye to ‘on call’ brings educational & quality of life improvements.

London’s “Hospital at Night”

How teamwork and innovation reduce hours while improving patient care.

Creative Ancillary Staffing at DC Children’s Hospital

New staffing positions increase the efficiency of resident physicians.

Internal Medicine, Summa Health System (video)

A video documenting how an Akron, Ohio program has successfully reduced on-call shifts to no more than 16 hours, without hiring any additional staff.

Shorter Hours, Fewer Nights: Life as a British Resident
To U.S. physicians, limiting resident work hours to 48 per week seems unimaginable. But to Elisabeth Paice, FRCP, dean of postgraduate medical education in London, it’s all part of effective medical training.

Alert & Awake For Everyone’s Sake

A Resident Work Hours Conference in New Zealand, where there have been a maximum of 16-hour shifts and 72-hour weeks since the mid-1980s.

Capping Hours at 12
Overcoming resistance at Coney Island Hospital in Brooklyn, NY to reforming resident work hours.


Resources for transforming your residency program

An Elusive Balance - Residents’ Work Hours and the Continuity of Care
An interview with Dr Ethan Fried, Program Director at St. Luke’s Roosevelt Hospital, about resident work hours reform and handoffs.

Work Decompression: Reducing the Workday to ≤16 Hours in Three Residencies
Powerpoint presentation from 2010 APDIM Spring Meeting featuring Work redesigns at Summa Health System, Hennepin County Medical Center and Virginia Mason Medical Center

Focusing on Sign-Outs
An ongoing opportunity for improved patient safety.

32 Ideas for Achieving Work-Hours Compliance
Practical suggestions from a surgical residency program director.

Best Practices In Brief
A synopsis report from a 2003 Hours Reform Conference in Los Angeles, CA.

Evaluation of a Redesign Initiative in an Internal-Medicine Residency
A New England Journal of Medicine Article designs an experimental inpatient-medicine service at Brigham and Women’s Hospital and Measures Trainee Satisfaction.

The Case for 16 Hours
Dr. Christopher Landrigan of the Sleep and Patient Safety Program uses a PowerPoint presentation to make his case based on the evidence.

Medical and Genetic Differences in the Impact of Sleep Loss on Performance: Implications for Work-Hour Standards
Charles Czeisler, Director of the Division of Sleep Medicine at Harvard Medical School, presented this PowerPoint to the ACGME Task Force in December 2009.

Surviving and Thriving Without 24 Hour Call: The Art and Science of Schedule Re-Engineering
Two presentations given at the 2010 ACGME Educational Conference in Nashville, TN



ACGME Hours Task Force in December 09