Table 7.

The IPRO experience – enforcing the bell regs in New York state

1984	Resident physician work hours received public attention after death of Libby Zion in NYC.
1987	NYS forms Bell Commission and becomes only state to establish work hour regulations for medical training programs: Bell Regulations: 80 hours/week (no averaging); Limit on consecutive on-call shifts 24 +3 additional hours; 8 hours off between assignments, 1 day off/week (no averaging); ER shifts 12 hours.
1998	Surprise inspections of 12 NY hospitals find them in flagrant violation of Bell Regs.
1999	Cardiology fellow dies in car accident after night on call – raises public attention.
2000	NYS legislature provides funding for monitoring of hospitals for Bell compliance.
2001	IPRO awarded 3 year contract to monitor and begins annual unannounced survey visits to every teaching hospital in the state. Resident physicians –and the public – can contact IPRO directly to report violations.
Cost	Approximately $18,000 per facility for an annual visit.
2005 and 2010	IPRO awarded 3 year grant renewals.
Lessons Learned: Unannounced visits are key – Examine records, interview residents, look to see what non-physician work residents are doing. Work with hospitals and encourage quality improvement initiatives. Fines from $5,000 to $20,000 per citation on the Hospital Board and CEO are taken seriously. Have increased compliance from 36 to 93% by working with stakeholders (hospitals, hospital associations, NYS Department of Health and Committee of Interns and Residents).
	Veronica Wilbur RN, BSN, MBA, Senior Director, IPRO New York State Harvard IOM Conference presentation, June 18, 2010