Transcript New Haven Needle Exchange Program

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
– paid (first years: $48,270.96 at Northwestern)
• Fellowship (subspecialties)
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
Work Rules
• NY State Libby Zion law (1989)
• From accreditation body (ACGME, 2003)
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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
Scheduling Problem
• Hospital’s (cheap labor) perspective
• How to cover various areas
– Rotations in Duke hospital, and
– Nearby hospitals
• Without violating the law
Formulation
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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
Formulation
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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)
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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
Criticism
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A year is scheduled at a time
Educational component?
Ensuring coverage not a compelling constraint
Hospital could hire more
– Residents
– Doctors