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

author/funder, who has granted medRxiv a license to display the preprint in perpetuity. Figure 1B ) for a schedule with 18 nurses, 3 attending physicians and 6 house-staff with physician rotations duration of four days. The designs simulated vary by whether they are staggered versus un-staggered, whether they have 8-hour nurse shifts versus 12hour nurse shifts, and whether nurses work consecutive days versus work alternating days. Note that in our simulations with nurses working consecutive days, when the physician rotations are sufficiently short, the nurses work the same number of consecutive days as the physician do; however, if the physician rotations are too long, the nurses are scheduled to work as many consecutive days as possible without exceeding 48 hours of work in the span of one week, and without exceeding 36 hours/week on average. Of note, due to unknown variables in the model, these plots do not suggest that the actual probability of team failure lies in the 20-60% range, but rather the plots are intended to demonstrate the relative improvement of various staff scheduling changes. From the plots in Figure 1A , and from similar plots that we generated with varying choices of the unknown parameters, we observe that scheduling designs with un-staggered rotations, 12-hour nursing shifts over consecutive days are favorable, and further, the probability of team failure is lower when all HCWs work at least 3-4 consecutive days. Figure 1B illustrates five designs for the case where the physician rotation duration is four days. Each physician is represented by a unique color. In each shift there are three nurses (triplet). The identity of the nurses in each triplet is fixed as long as all nurses in the triplet are healthy. Each triplet is represented by a unique color. The right column in Figure 1B describes the different schemes and also serves as the legend of Figure 1A .