Anesthesia Scheduling

Anesthesia Scheduling

Although complex Anesthesia staff scheduling requirements and the related difficulty of manual scheduling has been understood for many decades, scheduling software to date have only improved the efficiency of viewing and entering schedules by hand.  In these systems, the system may actually produce schedules very quickly, but also poorly when schedules are complex. These solutions, in effect, only change the medium of manual scheduling into an electronic form. Lightning Bolt’s newly introduced NSight system is the first scheduling software with a rule-based scheduling engine that finally delivers on the promise of a software-based solution. The system makes scheduling decisions by effectively thinking millions of steps ahead to produce a schedule that meets the complex requirements often found in Anesthesia schedules.

The complex requirements of Anesthesia scheduling have been understood for many decades.  Although the scheduling needs of anesthesia groups are unique, they often share some common requirements:

 

  1. The need to equalize different types of calls at different priorities. For example, calls that land on weekends and holidays are equalized at a higher priority than calls that land on weekdays.
  2. The need to ensure that time or spacing between calls, especially difficult ones is maximized. For example, avoid back-to-back first calls and avoid consecutive weekends on call.
  3. The need to observe complex call patterns based on call positions such as a doctor taking the first call on one day shall take the last call slot the next day; the doctor on second-call shall take the next-to-last call slots, etc. These patterns need to be flexible in that the actual call slot that a doctor takes on the very next day may vary depending on the number of doctors that are unavailable that day. Many doctors being unavailable on the very next day shall require the doctor on call to take a higher call position. The actual pattern also needs to adjust to any changes in staffing levels as doctors join or leave the call group.

  4. Doctor taking the first call on Saturday shall take the second call on Sunday. Depending on the group, there are several variations on the basic requirement. Some patterns relate the doctor on call on Friday with a call assignment on Sunday, for example.

 

For almost as long as these requirements have been understood and recognized as being non-trivial to implement, there has been the promise of a computer-based solution. Several software vendors offer packages that have improved over the decades.  However, these improvements have largely been improvements in the way the schedules are viewed or the way the schedules are manually entered using a computing device.  The most notable improvements are that users can create/view schedules on a centralized web-based application.  Another improvement is that users can view schedules conveniently on hand-held devices. Put differently, new generations of anesthesia scheduling software have changed the medium of entering and viewing schedules but a solution to the fundamental problem of creating good schedules that meet above requirements automatically has been largely elusive.

Lightning Bolt’s new scheduling system fundamentally changes how computers are employed by producing the best schedule possible. The system utilizes novel techniques in Artificial Intelligence and Operations Research where each scheduling choice of a doctor or a call slot is a choice made with the computational wisdom of having effectively examined several million steps. The result is a schedule that is often better than what is possible to do by hand alone and a resulting schedule that requires little or no manual “buffing.”

 

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Anesthesia Scheduling Sample Schedules

Check out sample schedules by clicking on the image.

 

 

Anesthesiology Sample Schedule
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Anesthesia Scheduling Sample Rules/Requirements

Rule #
Description
Priority

1

Track and equally distribute the total number of weekend calls, holiday weekend calls, holiday calls, and Thursday calls

Very High
2

Equally distribute the total number of weekday calls

High
3

No back-to-back weekend calls

Very High
4

No weekend call for next three weekends if scheduled on a weekend call

Medium
5

First call slot does the last available call slot, second call slot does next to last available call slot. Available number of call slots vary depending on number of doctors on vacation.

Maximum
6

Dr. Smith is a new doctor. Ease him into the schedule by initially scheduling only three 4rd and 5th call slots the first month and only ten 2nd through 5th call slots during the first two months. 

High
7

No consecutive days on primary call

High
8

At least ten doctors must staff the hospital daily

Medium
9

During the ASA Conference, as many 7 doctors can be out. On other days, only 5 doctors can be gone.

High
10

Look back two years in distributing the calls evenly

High
11

Dr. Smith takes at most 50% of the calls

High
12

Only Dr. Smith and Dr. Jones can take Heart Calls

Very High
13

Dr. Jones is not available to start with the group until June 4th

Medium High
14

At least one of four doctors on call must be a heart doctor

Maximum
16

Request Manager: At least 2 pain doctors must be available (not on Vacation)

Medium
17

Request Manager: Providers can request up to 10 days in a row off

Maximum
18

Request Manager: Providers can only request 2 weekends off per month

Maximum
19

Request Manager: Only a total of 6 providers can request Vacation, CME, PTO per day

Maximum
20

Request Manager: Each provider gets X number of CME, PTO days per year

Maximum
21

Request Manager: Providers may only request 2 no-calls per month

Maximum

Anesthesia Scheduling Challenges

Schedule creation and maintenance is time consuming.

Generating schedules takes several hours to several days. Even creating one week of schedule for a small group of physicians can take anywhere from several hours to several days. The difficulty increases dramatically with more physicians and/or more tasks to be scheduled.
Lightning Bolt NSight saves time. After defining the scheduling policies in the initial setup, Lightning Bolt NSight generates a new schedule on the click of a button. Once the system generates a schedule, users can modify it if desired. Lightning Bolt NSight typically reduces the time to create and maintain schedules by approximately 90%. The software typically pays for itself within the first year by saving time on producing schedules.

Equitable distribution of work is not so easy

Vacation requests, the need to cover sub-specialty tasks, and work preferences of individual providers make it difficult to distribute work evenly across providers with unique scheduling profiles.
Lightning Bolt NSight schedules fairly. Lightning Bolt NSight allows you to specify your group’s definition of equality based on FTE values or specific target numbers for each provider. It keeps separate counters internally for each area that you want to track. For example, you could specify that weekends and holidays need to be tracked separately. The system can be configured to produces schedules that converge to desired tallies over the long run based on past periods.

Is the schedule simply not possible mathematically?

Is the schedule the way it is because I can’t find a good schedule or is it simply not possible mathematically? How many vacation days can each provider take per year? Can each provider work only two weekends per month? Do we have enough providers to cover all the outreaches and sites? How many locums do we need to cover shifts given the work preferences of regular staff? What’s the impact on the work schedule of existing providers if we add a certain sub-specialist? These are simple questions but the answers are not so simple because of the interaction of rules and how a small change brings large changes to schedules in chaotic systems.
Lightning Bolt NSight lets you explore the precise edge of what is possible. A schedule draws a line between individual needs and institutional need; between patient volume/quality of care and provider needs; between individual needs and collective needs. Lightning Bolt NSight helps you analyze and explore the boundaries unique to your group. Can each provider be limited to two weekends per month? If yes, the system will produce a schedule with that limit. If not, it will let you know. Can the work shifts be covered by available staff? If yes, the system will produce a schedule covering all work shifts. If not, it will help you determine how many additional staff you will need. These are examples of questions and answers at the edge of what is mathematically possible, an edge that you can explore with Lightning Bolt NSight.

Our Scheduler is no longer available

The scheduler who has been doing our schedule for 15 years is no longer available. What do we do now? Because of the complexity of schedules, schedulers have often acquired much domain knowledge on the logic required to create a good schedule. They may have picked up many tricks, which might involve a sequence of complex steps in producing schedules. Often, schedulers would create schedules in layers. If the scheduler is suddenly no longer able to do the schedule, this poses an operational risk to the group especially if there was no time to plan the transition.
Lightning Bolt NSight offers a medium of transferring scheduling know-how. With Lightning Bolt NSight, since the system is already configured to produce schedules automatically, a new scheduler only needs to learn to click the button to produce the schedule!!! As a result, the system continues to produce good schedules across this transitional period for the group.

Time-off requests cause coverage problems.

Time-off requests cause coverage problems. Schedulers would like to accommodate individual time-off needs to the extent possible. However when individual requests are unchecked, the collective requests causes coverage problems when too many providers are unavailable on the same day. When the group consists of sub-specialists that are not interchangeable, determining potential coverage requires a complicated calculation based not only on the number of absent providers but which combination of sub-specialists are absent. Not knowing which combination causes problems, the administrator faces a difficult choice in being overly conservative by denying requests that could be honored or being overly aggressive and face coverage problems when creating schedules later.
Request Manager ensures coverage. With the optional Request Manager, users enter absence and other requests online, and the Request Manager approves or denies requests based on potential coverage problems and other user defined rules. Request Manager uses a sophisticated algorithm that determines whether a given sub-specialist can be absent based on the number of sub-specialists required and the current list of providers who have already been approved for absence on that day. This allows the maximum number of providers to be off on a given day while ensuring that there will be no coverage problems.

Why is the schedule the way it is?

Why is the schedule the way it is? Physicians who live the schedule often seek an explanation as to why they are or are not scheduled on a particular day. Not knowing the collective rules and constraints, the choice of a particular schedule or a scheduling decision may seem random or biased.
Lightning Bolt NSight explains. The rationale behind a scheduling decision is particularly important when the schedule is automatically generated. Lightning Bolt NSight offers detailed explanations of its decisions and displays violations of rules when they are unavoidable because of conflicts.

Only thing constant in our group is change

Only thing constant in our group is change – changes due to changes in staffing levels and/or work demand. Schedules often need to adapt to changing events whether that event is due to a provider being unavailable due to illness, taking a leave of absence, or new providers joining the group. Just when the group is adapting to a period of change, a new schedule needs to be generated that takes the new events into account. Often, even a small change has large impact on the overall schedule.
Lightning Bolt NSight adapts. With Lightning Bolt NSight, any portion of the schedule can be revised with the click of a button whether the portion needing revision is a day, a week, month or a year. When a new event occurs, you simply re-schedule the remaining period or a period specified by a start and a stop date.

Schedules can be misplaced or outdated.

Schedules can be misplaced or outdated. Where is the latest schedule? Modifications often need to be made after the distribution of the initial schedule. For example, physicians may need to swap shifts with each other. Maintaining the current and latest schedule can be difficult if it's on a static piece of paper or on a spreadsheet on someone's computer.
Lightning Bolt NSight has the latest schedule. With Lightning Bolt NSight, there is a central place for the latest schedule. The schedule can also be published on a password protected website which can be viewed from anywhere you have internet connection. Users having sufficient access privileges can also swap shifts online, keeping the schedule current. These changes are not only reflected on the central website but also on any mobile device via calendar subscriptions which allows users to automatically sync their mobile device with the information on the Lightning Bolt web application.

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Autumn Moser, M.D.

"Lightning Bolt was the only scheduling system we looked at that had the flexibility and sophistication to accommodate our many needs."

Providence Health Systems - Everett Clinic, Everett, WA
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