Emergency Scheduling

Vol. 41, No. 6, November–December 2011, pp. 521–533
issn 0092-2102 eissn 1526-551X 11 4106 0521

http://dx.doi.org/10.1287/inte.1110.0563
© 2011 INFORMS

Building Cyclic Schedules for Emergency
Department Physicians
Yann Ferrand, Michael Magazine, Uday S. Rao
Department of Operations and Business Analytics, University of Cincinnati, Cincinnati, Ohio 45221
{ferrany@mail.uc.edu,mike.magazine@uc.edu, uday.rao@uc.edu}

Todd F. Glass
Cincinnati Children’s Hospital Medical Center, Liberty Campus, Cincinnati, Ohio 45229, todd.glass@cchmc.org

Physicians at a branch of the emergency department at Cincinnati Children’s Hospital Medical Center complained that their schedules were too erratic because of the multitude of operating requirements, regulatory
constraints, physicianpreferences, and holiday requests. We addressed this issue by using integer programming to build cyclic schedules that can be repeated throughout the year. These schedules are flexible enough
to handle incorporating holidays, work assignments, and vacation requests ex post. After we rolled out the
calendar-year-based cyclic schedule, we captured statistics to assess the viability and the quality ofthe yearly
schedule generated. Surveys of the physicians and the scheduler after implementation showed that the new
schedule provides predictability and well-balanced work patterns.
Key words : health care: emergency department physician scheduling; cyclic schedule; integer programming
applications.
History : This paper was refereed. Published online in Articles in Advance September 30,2011.

C

incinnati Children’s Hospital Medical Center
(http://www.cincinnatichildrens.org), a premier
children’s hospital, recently opened an additional
emergency department in a suburban area. Typical of
emergency departments, this facility operates 24/7,
and must be staffed accordingly. In this environment,
the emergency physician is one of the key personnel,
and his/her work schedulemust be built carefully to
meet operating requirements, regulatory constraints,
and physician preferences. Operating requirements
pertain to physicians’ workloads at a given location;
regulatory constraints include, for example, the number of hours of rest required between two working shifts; physicians need at least a 16-hour break
between working shifts. Physician preferences comprise thework patterns, especially as they relate to
the circadian rhythm of the human body; changing a
work pattern from late in the day to early the next day
is more strenuous on the human body than changing it from early to late in the day. These requirements include a multitude of constraints and render
the work of the scheduler (i.e., the person responsible

for developing the schedule) achallenging task, even
when software support is available.
Physicians’ schedules have traditionally been built
around their requests for time off. The ruling
paradigm is that physicians’ requests for time off
(i.e., holidays and vacations) are guaranteed to be
honored, provided they are made with reasonable
notice and respect for administrative rules of seniority and fairness. After determiningthe time off for
each physician, the scheduler assigns the working
shifts, ensuring that all the necessary constraints are
met. At Cincinnati Children’s Hospital Medical Center, this effort, albeit tedious, is accomplished by using
Web-based scheduling software, Peake Software Lab’s
Tangier Web (http://www.peakesoftware.com). This
software keeps track of operating requirements andregulatory constraints, which helps the scheduler as
she develops a schedule that aims at accounting for
physician preferences.
The scheduler develops schedules for the group of
physicians working at the branch emergency department (the branch) and for all other physicians working at the base emergency department (the base) of
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Ferrand et al.: Building Cyclic Schedules for Emergency...