Smalley Hannah K, Keskinocak Pinar
, Knoxville, TN, USA.
H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, 755 Ferst Drive, Atlanta, GA, 30332, USA.
Health Care Manag Sci. 2016 Mar;19(1):66-88. doi: 10.1007/s10729-014-9289-8. Epub 2014 Aug 30.
At academic teaching hospitals around the country, the majority of clinical care is provided by resident physicians. During their training, medical residents often rotate through various hospitals and/or medical services to maximize their education. Depending on the size of the training program, manually constructing such a rotation schedule can be cumbersome and time consuming. Further, rules governing allowable duty hours for residents have grown more restrictive in recent years (ACGME 2011), making day-to-day shift scheduling of residents more difficult (Connors et al., J Thorac Cardiovasc Surg 137:710-713, 2009; McCoy et al., May Clin Proc 86(3):192, 2011; Willis et al., J Surg Edu 66(4):216-221, 2009). These rules limit lengths of duty periods, allowable duty hours in a week, and rest periods, to name a few. In this paper, we present two integer programming models (IPs) with the goals of (1) creating feasible assignments of residents to rotations over a one-year period, and (2) constructing night and weekend call-shift schedules for the individual rotations. These models capture various duty-hour rules and constraints, provide the ability to test multiple what-if scenarios, and largely automate the process of schedule generation, solving these scheduling problems more effectively and efficiently compared to manual methods. Applying our models on data from a surgical residency program, we highlight the infeasibilities created by increased duty-hour restrictions placed on residents in conjunction with current scheduling paradigms.
在全国的学术教学医院中,大部分临床护理工作由住院医师承担。在培训期间,住院医师经常在不同医院和/或医疗科室轮转,以最大化他们的学习收获。根据培训项目的规模,手动制定这样的轮转计划可能既繁琐又耗时。此外,近年来对住院医师可允许的值班时长的规定变得更加严格(美国研究生医学教育认证委员会,2011年),这使得住院医师的日常排班更加困难(康纳斯等人,《胸心血管外科杂志》137:710 - 713,2009年;麦科伊等人,《梅奥临床学报》86(3):192,2011年;威利斯等人,《外科教育杂志》66(4):216 - 221,2009年)。这些规定限制了值班时长、一周内可允许的值班小时数以及休息时间等等。在本文中,我们提出了两个整数规划模型(IPs),目标是:(1)在一年时间内为住院医师创建可行的轮转分配方案;(2)为各个轮转制定夜间和周末值班排班表。这些模型涵盖了各种值班时长规定和限制条件,具备测试多种假设情景的能力,并且在很大程度上实现了排班生成过程的自动化,与手动方法相比,能更有效、高效地解决这些排班问题。将我们的模型应用于一个外科住院医师培训项目的数据,我们突出了与当前排班模式相结合的、对住院医师增加的值班时长限制所造成的不可行性。