1 / 9

Scheduling Surgery Residents

Scheduling Surgery Residents. New rules limit work hours Scheduling problem Interesting context. Medical Education in the US. Bachelor (4 years) Medical School (4 years) $42,974/year tuition at Northwestern Residency 3-7y, 5y for general surgery

celeste
Télécharger la présentation

Scheduling Surgery Residents

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Scheduling Surgery Residents • New rules limit work hours • Scheduling problem • Interesting context

  2. Medical Education in the US • Bachelor (4 years) • Medical School (4 years) • $42,974/year tuition at Northwestern • Residency • 3-7y, 5y for general surgery • paid (first years: $48,270.96 at Northwestern) • Fellowship (subspecialties)

  3. Residency • Training of doctors • Cheap labor • Funded by Medicare • “If you have one less nurse, then you've saved $40,000. If you have one less resident, you've saved $40,000, but you've lost $100,000 in reimbursement.” • Limited supply • The “Match” and the “Scramble” • Working conditions

  4. Work Rules • NY State Libby Zion law (1989) • From accreditation body (ACGME, 2003) • Work week ≤ 80 hrs (over averaged over 4wks) • ≤1 on call night every 3 days • 30 hr max shift • 10 hr between shifts • Routinely flouted • Does not apply to fellows • Controversy • Reducing medical errors • Getting necessary medical training

  5. Scheduling Problem • Hospital’s (cheap labor) perspective • How to cover various areas • Rotations in Duke hospital, and • Nearby hospitals • Without violating the law

  6. Formulation • Seeking a schedule for a week • MIP feasibility problem • I = set of residents • J = services to cover • Includes other hospitals • Includes time-off • K = set of 4 hr time slots • xijk = 1 if resident i covers service j at time k • binary

  7. Formulation • zij=1 if resident i does rotation j (binary) • ∑j zij ≤ 1 (at most one rotation in a week) • ∑k xijk ≤ 20zij (80 hrs/rotation limit) • ∑j xijk ≤ 1 (one thing at a time) • ∑ik xijk ≥ 1 (at least one available at each loc) • 2xi,11,k+xi,11,k+1+xi,11,k+2 ≥ 2xi,11,k-1 (breaks ≥ 12hr) • …

  8. Sample Result • 1st year resident in trauma rotation • Schedule • Monday 6am to Tuesday 6am • Tuesday 6pm to Wednesday 6am • Thursday 10am to Friday 6am • Saturday 6am to Sunday 2am • 76 hours total

  9. Criticism • A year is scheduled at a time • Educational component? • Ensuring coverage not a compelling constraint • Hospital could hire more • Residents • Doctors

More Related