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Free Scheduling Templates

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					Developing a Schedule


 Brigitte M. Baumann, MD, DTM&H
    UMDNJ-RWJMS at Camden
        Objectives
History
Scheduling Requirements
Principles
Scheduling Tools
Dealing with Crises
                              March 6, 1984
Libby Zion, a freshman at Bennington
College in Vermont and the daughter of
the writer and lawyer Sidney E. Zion and
his wife, Elsa, died of cardiac arrest
yesterday at New York Hospital after a
brief illness. She was 18 years old and
lived with her parents in Manhattan.
     Libby Zion
18 yo admitted to NYH for viral
syndrome
Prescribed meperidine (Demerol) for
chills and “agitation” (2 AM)
LZ already taking phenelzine (Nardil)
an MAO inhibitor
Combination of 2 drugs 
Noradrenergic Syndrome
(hypertensive crisis)
              Libby Zion

    After receiving the meperidine LZ noted
    to be restless, confused
    Intern already worked 18 hrs, ordered
    restraints and haloperidol
    6 AM, LZ with axillary temp of 42°C
   Respiratory arrest and died
   Father is an attorney and writer for NYT
               Libby Zion
Sidney Zion sued NYH and 4 MDs for medical
malpractice, alleged wrongful death of his daughter
Defense argued LZ failed to tell MDs about her
cocaine use
Feb. 1995
• 3 of 4 MDs negligent for giving LZ Demerol
• LZ 50% responsible for her own death
• MDs ordered to pay $375,000 to family for pain and
  suffering
• No punitive damages
• NYH cleared of wrong-doing
Indictment of the system
• Sleep deprivation
• Inadequate resident supervision
          Bell Commission
Headed by Dr. Bertrand Bell and 9 physicians
   Recommendations:
    – Limit resident work hrs to 80 / week
    – No more than 24 hrs of consecutive on-
      duty time
    – At least one 24 hr period off-duty each
      week
    – On-site attending supervision in ED and
      acute care inpatient units
    Current Scheduling
Requirements (ACGME / RRC)
   Duty hours = all clinical and academic
    activities related to residency program
   Duty hours ≠ reading and preparation
    time spent away from the duty site
   Must be limited to 80 hrs/week
   Residents must be provided with 1 day
    in 7 free from all educational and
    clinical responsibilities

                                   www.acgme.org
         Current Scheduling
           Requirements
   One day = “1 continuous 24 hour
    period free from all clinical, educational
    and administrative duties”
   Adequate time for rest and personal
    activities must be provided: 10 hour
    period between all daily duty periods
    and after in-house call.

                                     www.acgme.org
      Current EM Resident
    Scheduling Requirements
   While on duty in the ED, residents may not work
    longer than 12 continuous scheduled hours.
    There must be at least an equivalent period of
    continuous time off between scheduled work
    periods.
   A resident should not work more than 60
    scheduled hours per week seeing patients in the
    ED and no more than 72 duty hours per week.
   Duty hours comprise all clinical duty time and
    conferences, whether spent within or outside the
    educational program, including all on call hours.

Accreditation Council for Graduate Medical Education www.acgme.org
         Current Scheduling
           Requirements
   Moonlighting
    – May not interfere with the ability of the
      resident to achieve goals and objectives
      of the educational program.
    – Any hours a resident works for
      compensation at the sponsoring
      institution or sponsor’s primary clinical
      sites must be considered part of the 80
      hour weekly limit on duty hours.
    – “Internal Moonlighting”
                                       www.acgme.org
        Current Scheduling
          Requirements
   Oversight
    – Each program has to have written policies
      and procedures for resident duty hours
      and the working environment.
    – Back up support systems must be
      provided when patient care
      responsibilities are unusually difficult or
      prolonged, or if unexpected
      circumstances create resident fatigue
      sufficient to jeopardize patient care.
                                      www.acgme.org
       Current Scheduling
         Requirements
   Exceptions
    – An RRC may grant exceptions for up to
      10% of the 80 hour limit to individual
      programs based on a sound educational
      rationale. Prior permission of the
      institution’s GMEC is required.




                                    www.acgme.org
Scheduling Principles




 The Sleeping Gypsy Henri Rousseau, 1897
              The Basics

   Find someone else
   Divide and Conquer
   Develop a timeline
   Use a template
   Set guidelines for schedule requests
   Be fair
   Use Common Sense
             Chief Checklist
   Monthly or Annual?
   Obtain resident rotation schedules from PD
   Obtain information about non-EM residents
   Ask when PD wants schedules for review
    before distribution to residents
   Find out if any scheduling issues are
    looming ahead: Pregnancies, departing
    resident(s), potential personal issues with
    residents, residents undergoing remediation
             Chief Checklist
   Note important dates now:
    – Annual Program Review ________
    – Retreat _______
    – ABEM Inservice Exam Feb 28, 2007
    – National Meetings or Conferences
        ACEP Scientific Assembly Oct 15-18, 2006
        AAEM March 12-14, 2007

        SAEM Annual Meeting May 16-19, 2007
            Chief Checklist
   Make a master calendar
   Include all important dates
   Note the residents assigned to the ED
    for each month (and their PGY level)
   Note additional staffing (other non-EM
    residents)
   Alert PD if there is an imbalance
              Chief Checklist
   Ensure that off service rotations are aware
    of your program’s “off” days
    – Inservice exam
    – Retreat
    – National conferences
   Obtain “off days” for non-EM rotators
    – Poor form to have conflicts after the schedule’s
      been released
   Determine relationship w/ off service
    rotators
    – Who covers?
                Chief Checklist
   Work on the monthly schedule
   Develop a schedule template
    –   MS Word
    –   Excel
    –   Free systems / templates
    –   Fee for scheduling (lots of bells and whistles)
   Handout is provided listing commercial
    products. No endorsement of any product is
    intended, nor is this handout complete.
      Scheduling Software
ActiveSchedule
http://ncemi.asatte.org/cgi-bin/as_ncemi/
Free
Web-based scheduling program
Compiles statistics
Checks for errors in the schedule
Allows one to highlight a name
Reminds users about shifts
      Scheduling Templates
   Determine what is required by your PD
   Maximum and minimum # of hours
   Guaranteed days off
    – Weekends?
   Shifts before and during conferences?
   Clarify “Urban Legends” vs Reality
    – 2 weekends/month off
       Scheduling Templates
   8-9 hour shifts
    0700-1500/1600
    1500-2300/2400
    2300-0700/0800

   12 hour shifts
    0700-1900
    1900-0700
       Scheduling Templates
   Combination
    – 8 hours during the week
    – 12 hours on weekends
   Pros
    – Allows for family/personal time/reading
    – Maximizes weekend time off
    – Still provides 12 hr shifts (“Real Life”)
   Cons
    – Can make scheduling a bit more difficult
    – Requires greater staffing than pure 12 hr shifts
       Scheduling Templates
   Typical Sequences
    3 days / 2 off / 3 evenings / 2 off / 3 nights
    4 days / 1 off / 4 evenings / 1 off / 4 nights
   Sequence depends on ED resident
    staffing
   Difficult to maintain if multiple schedule
    requests (one change affects many)
         Circadian Rhythms
   Frame shift forward
    Days  Afternoons  Nights
   Aim for 2 days off after overnights
   Avoid conferences after an overnight
    – Off service rotators
    – Ensure equal distribution among
      EM residents
            Circadian Rhythms
   Block nights (1 Month of night shifts)
    – Disaster if a resident is unable to work
   Progressively later shifts with one night
    shift at end (impractical)
   Block nights each month (5 nights in row)
    –   Still disruptive
    –   May be the best option
    –   Easiest to schedule
    –   Favored by residents: “Get it over with”
           Schedule Request
              Deadlines
   Set up a repeating deadline each month
    – Resident requests due 2 months prior
    – PD schedule review 6 weeks prior
    – Distribution of schedule 5 weeks before it
      goes into effect
   Example (August Schedule)
    – Requests due 6/1
    – Schedule to PD 6/15
    – Distribute 6/22
   NO EXCEPTIONS
          Resident Requests
All requests should be written
 Email preferred
    – Timed and dated
    – Forces residents to check their email
   Grant requests on a “first submitted-first
    granted” basis
   Occasional “carrots” to the resident who
    comes to the schedule’s rescue
         Resident Requests
   Never take a verbal request
    – You’ll forget it
    – No record of the timing of request
    – Will become the default request method
    – You will lose sleep
    – There will be strife
                  Equity
   Be Fair
   Never give someone a schedule you
    would not give yourself
   Count nights and undesirable shifts,
    distribute equally
   Take the “bad” shifts
   Lead by example!
    Vacation Requests
   Ask for vacation requests at the
    beginning of the year
   Ensure requests are allowed by your
    program’s rules
   If multiple requests during one rotation
    – Discuss amongst residents
    – Lottery
   Follow requests and whether granted
        Record Keeping
Maintain a database with:
 Total # shift hours

 # days off (weekend vs weekday)

 Overnight hours

 Vacation / holiday hours

 Acceptance of

  “Scheduling requests”
Jeopardy / Sick Call
           Jeopardy / Sick Call
   Pros
    – Less stress on the schedule (and you)
      to find a replacement
    – Built in “cushion”
    – Allows residents to take time off rather
      than coming to work sick (and infecting
      everyone else!)
        Jeopardy / Sick Call
   Cons
    – Additional demand on the workforce
    – Who decides when someone can call
      out?
    – Additional scheduling and
      recordkeeping needed
    – Risk of abuse of the system
    Jeopardy / Sick Call Pearls
   Establish written guidelines
   The chief should be the intermediary
    between the person calling out and the
    person being called in
   Strongly consider “payback”
    requirement
    Jeopardy / Sick Call Pearls
   Payback should be to the “shift pool” not
    to the resident taking the call
   Keep track of who calls out and who
    comes in
   Schedule only PGY2’s and higher
   Schedule during light off service
    rotations
      Handling Crises




Drive George, Drive! This one’s got a coathanger!
             Handling Crises
   Schedule one chief to handle emergencies on
    a rotating basis
    – Jeopardy
    – Scheduling conflicts
    – “crises”
   The other chief works on schedule
   Rotate this duty
   Inform the residents: email / note on schedule
            Handling Crises
   Discuss with PD what s/he considers a crisis:

      One resident is ill with the flu, calls out sick

                        VERSUS

      Several residents involved in an MVC and are
      being evaluated at a local ED – severity of
      injuries unknown
              Handling Crises
   First think about a plan / options
    –   Call in jeopardy?
    –   Call in residents who are on electives?
    –   Can off service rotators be used to cover?
    –   Come up with a plan!
   Call PD and/or Asst PD
    – Discuss plan and decide on plan of action
   Implement plan
      Handling Crises: Case
   You have 6 IM residents working in
    your dept in June. 5/6 are in a
    bridal party for resident # 6 who is
    the bride. All are requesting the
    same days off.


     What do you do?
     Handling Crises: Case
A. Curse the IM chiefs for assigning all
  these people to the ED for that month
B. Refuse all requests including the bride’s
C. Refuse all requests except the bride’s
D. Make everyone happy and have the EM
  residents cover the shifts (stretching the
  duty hour rule) and profuse profoundly
E. Call the IM chiefs, explain the coverage
  you need and have them make the
  (unhappy) decision(s)
               Final Points
   Make sure you know the pre and post
    rotations of the EM residents for the
    month you are scheduling
   If there is “fat” in the schedule, double
    cover high volume days and times
   Have non EM-rotators cover
    conferences
   Ensure that a senior is always “on”
                 Summary
   Follow the ACGME guidelines
   Be fair: Aim for win – win scenarios
   Use common sense
   Check and double check for mistakes
   Contact the PD if in doubt
   Admit when you made a mistake (and
    apologize)
   Use your resources and ask for help!
Questions?

				
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