Impact of healthcare worker shift scheduling on workforce preservation during the COVID-19 pandemic

Dan M Kluger; Yariv Aizenbud; Ariel Jaffe; Lilach Aizenbud; Fabio Parisi; Eyal Minsky-Fenick; Jonathan M Kluger; Shelli Farhadian; Harriet M Kluger; Yuval Kluger

To illustrate how scheduling decisions affect infection rates, in Figure 1 we simulate two hospital teams, each including six house-staff or advanced practice providers (APPs) and three attending physicians, two house-staff/APPs and one attending on rotation at a time. The first team had 30 nurses (five/shift), and the second 18 nurses (three/shift.) The average number of patients is set to 15/day (5 per nurse or 3 per nurse, in settings with different patient acuity.) Under normal circumstances, personnel rotations are staggered to ensure continuity of care and broad exposure for trainees to attendings and patients to enhance their educational experience. Rotation duration is also geared towards minimizing HCW fatigue. In a pandemic, these factors are considerably less important than HCW preservation. We compared scheduling options to minimize team failure, defined as the event that at some point there are insufficient attendings or housestaff/APPs to staff a fully functioning floor or insufficient healthy nurses to limit weekly hours to 48. Under all scenarios modeled each nurse works an average of ≤36 hours/week. Figure 1 depicts five staff scheduling scenarios for mean patient hospital stays of two and five days, typical for maternity and medicine floors, respectively, indicating team failure probability as a function of physician rotation length. We simulate situations in which cohorts of nurses co-rotate with physician rotations compared to nursing schedules that are independent of physicians.