Goal:

In accordance with AGME requirements neurological surgery residency will:

• Educate all faculty members and fellows to recognize the signs of fatigue and sleep deprivation.
• Education all faculty members and trainees in alertness management and fatigue mitigation processes.
• Encourage trainees to use fatigue mitigation process to manage the potential negative effects of fatigue on patient care and learning.

Policy:

1. Annual presentation will be given to all trainees to include recognizing signs of fatigue and sleep deprivation, strategies to manage fatigue when possible, and how to safely and effectively transfer clinical responsibilities.
2. Trainees are required to monitor for signs of fatigue that may occur after prolonged periods without sleep which may include but are not exclusively:
   1. Sluggish thought
   2. Inability to concentrate
   3. Inability to stay away without eternal stimulation
   4. Change in behavior – irritability, anger, intolerance, outbursts
   5. Physical changes including nausea or abdominal cramps in the absence of illness
3. Trainees are required to utilize methods taught for fatigue mitigation to minimize clinical impact of trainee fatigue
4. In the situation of fatigue casing impairment to ability to perform one’s clinical responsibilities, the trainee must:
   1. Safely transfer clinical responsibilities to another trainee
   2. It is the trainee’ responsibility to have a contingency plan if they become too fatigued to perform clinical duties safety
   3. If the trainee is unable to find another qualitied trainee to assume clinical responsibilities, the supervising attending must cover the clinical responsibilities or make arrangements for transfer of the responsibilities.
5. Adequate sleep facilities at all major participating training sites and safe transportation options for trainees who may be too fatigued to safely return home are provided.
6. If the trainee or supervising attending feel the resident is too fatigued to drive home safely either after completion of scheduled duty hours or after transfer of care, the trainee has the following options:
   1. Sleep in the available call room until able to drive safely home
   2. As a fatigue mitigation transportation option to help ensure trainee get home safely when fatigued after work, reimbursement is available to any trainee that elects to use transportation service to get home instead of drive their own vehicle while fatigues. Use of service will be monitored.
      1. Utilize the service of your choice (app-based or taxi) for a ride home and then use the service again to pick up your car or return to work the next day. This service is available to use any time trainees feel fatigued at the end of their shift. We do not want any trainee to drive when they are overly fatigued. Program directors will be notified if transportation for fatigue is used more than twice a month. This is so that a determination can be made as to the case of persistent fatigue and if a schedule adjustment needs to be made.
      2. The department can arrange for a taxi voucher to transport the trainee home.
   3. For reimbursement, trainees will need proof on the receipt of going to a verifiable home address and round trip from a verifiable UUH training site. Any verifiable training site is acceptable for a pick up or drop off location. All receipts must include a starting location, ending location, time, date, trainee name and total fare for basic service. If a tip is provided, it must be included within the total fare, not as a separate line. If you are using a taxi and the receipt does not include the information above, please provide any information missing from the receipt that is noted above. If you are using UBER (or similar service), the department will only reimburse for basic service so please make sure you select basic service and not luxury service. Receipts for fatigue mitigation transportation must be received by the program manager within 20 days of the travel date to be eligible for reimbursement. Please provide the program manager with either original or scanned receipts for reimbursement