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Improving ACGME Compliance using Resident run Lean Process
Frederick H Millham¹, *Suliat Nurudeen², *Joseph Mets², *Christopher Burns¹, Douglas Smink^2
1South Shore Hospital, Weymouth, MA;²Brigham and Women's Hospital, Boston, MA

Objective: To improve ACGME work hours compliance. Design: Prospective Longitudinal Before and After Study Setting: Regional Hospital Participants: Surgical Residents and Faculty Intervention: We used Lean Process Improvement methods to re-design resident work patterns. We used structured brainstorming, precise process mapping, experimentation and real-time measurement of compliance and a balance measure. Changes shown to improve compliance in short experiments included: 1) Shortening the overnight shift, 2) Better defining resident roles, 3) Establishing a period free from new assignments, 4) Holding a weekly compliance meeting, 5) Education regarding ACGME rules. Main Outcome Measures: 1) Resident work hours of less than 80 averaged over four weeks, 2) Average of one day off per week averaged over four weeks, 3) Maximum work day of 16 hours for interns and 24 hours for other residents, 4) a minimum 10hr break between shifts and 5) Percent of surgeries with resident participation before and after intervention. Results. Prior to intervention 20 work hour violations over 231 resident-days(PGY1)( p<0.001); 12 work hour violations over 278 resident-days(PGY2)( p=0.001). There were no violations in either following the intervention, over periods of 227 resident days and 234 resident-days respectively. Work hour violations by PGY4 resident were unchanged by the intervention, occurring twice in 91 resident-days before and four times in 94 resident-days after intervention. Resident involvement in surgical procedures was unaffected by the intervention; 72% of general surgical procedures having a resident assistant before and 75% after the intervention. Conclusion: A resident-led, Lean program can improve work hours compliance by junior residents without affecting resident participation in surgery. Compliance by Chief residents was unaffected by the intervention.

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