MEDICAL RESIDENT WORK SCHEDULES - DESIGN AND EVALUATION BY SIMULATIONMODELING

Society has demanded reform in medical resident work scheduling; conse quently, hospitals are implementing changes having organizational, cli nical, financial, social, emotional, and educational consequences for physician training and patient care. We report the use of simulation m odeling as an approach to evaluate the outcomes of alternative designs prior to implementation. Mobile resources such as physicians with com plex job descriptions and patients with time-varying arrival processes complicated the modeling task. A flexible, powerful simulation langua ge helped to model resource decision rules and the frequent preemption s of less urgent activities as more urgent requests arise. A distribut ion fitting package enhanced the synthesis of data from diverse source s into distributions that adequately modeled input processes. The resu lting simulation model was used to examine alternatives in the design of a new housestaff work schedule. We were able to predict accurately the effects on the sleep and activity profile of interns when their sc hedules were modified. Furthermore, this model has remained an asset f or investigating consequences of many types of variation within the sy stem, including changes in patient demand as well as numbers or job de scriptions of the housestaff.