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:
- 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.
- 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.
- 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.
- 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. Some even offer the ability to view schedules in different background colors. 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.”
Anesthesia Scheduling Sample Rules/Requirements
Track and equally distribute the total number of weekend calls, holiday weekend calls, holiday calls, and Thursday calls
Equally distribute the total number of weekday calls
No back-to-back weekend calls
No weekend call for next three weekends if scheduled on a weekend call
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.
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.
No consecutive days on primary call
At least ten doctors must staff the hospital daily
During the ASA Conference, as many 7 doctors can be out. On other days, only 5 doctors can be gone.
Look back two years in distributing the calls evenly
Dr. Smith takes at most 50% of the calls
Only Dr. Smith and Dr. Jones can take Heart Calls
Dr. Jones is not available to start with the group until June 4th
At least one of four doctors on call must be a heart doctor
Request Manager: At least 2 pain doctors must be available (not on Vacation)
Request Manager: Providers can request up to 10 days in a row off
Request Manager: Providers can only request 2 weekends off per month
Request Manager: Only a total of 6 providers can request Vacation, CME, PTO per day
Request Manager: Each provider gets X number of CME, PTO days per year
Request Manager: Providers may only request 2 no-calls per month