The Practice Success Prescription: Team-Based Veterinary Healthcare Delivery by Drs. Leak. Morris Humphries
Thomas E. Catanzaro, DVM, MHA, FACHE, DACHE
High-density Scheduling
Extract from Zoned Systems & Schedules in a Multi-doctor Practice, a VCI® Signature Series Monograph, with disk, Veterinary Consulting International®, 2003 (www.drtomcat.com)
Geography
1. Any ten-minute interval log will work (paper or computer). Most practices use twenty minutes as their basic appointment, while a few ignore the Pfizer study that states eight-seven percent of the clients want to be and out in twenty minutes or less, and they schedule three blocks of ten minutes each per appointment. In both cases, the first ten minutes of the subsequent appointment in the adjoining room overlaps the last ten minutes of the original appointment.
2. The practice schedules available consultation (exam) rooms, rather than doctors, with multiple rooms per doctor. We start with two per doctor, but have seen as many as six per doctor for the well-staffed and experienced doctors.
a. We prefer to use to foci for starting the schedule. For example, 9:30 a.m. and 4:00 p.m., then offer open slots to either side of the foci for scheduling appointments in a stair-step, slowly expanding fashion.
b. We want to give clients two "yes" options when scheduling: "Morning or afternoon? 9:25 or 9:35?... That is fine, we have you with Dr. Smith at 9:35 a.m., Tuesday, June 12th. Do you want me to send you an e-mail to remind you?"
c. When talking to clients, we do not recommend scheduling doctors by their name initially, we want that saved to the very end. At the very end, we verify when and with which doctor the appointment has been made, unless the client specifically has asked for a doctor by name. In that case, we again offer two "yes" alternatives: "Dr. Jones has an appointment at 4:05 this afternoon, or you can bring in White Fang this morning with Dr. Smith, for a drop-off admission, and we can schedule a discharge appointment with Dr. Jones. Which do your prefer?"
3. We prefer odd number consultation (examination) room arrays, so at least one room (odd room) will remain available for walk-ins, technician appointments, and/or emergencies.
4. The client relations team (receptionists) will control access within the following guidelines:
a. A "standard" appointment is twenty minutes.
b. A second/third pet gets one additional ten-minute slot added.
c. An exotic case, ophthalmology, or other atypical case gets an extra ten minutes.
d. A new client gets an extra ten minutes added to the standard twenty minutes.
e. A new veterinarian graduate gets an extra ten minutes added to everything.
5. A doctor-nurse team, both of whom have completed the five phases of training, has two consultation (examination) rooms scheduled concurrently, but out of sync. The last ten minutes in one room overlaps with the first ten minutes in the second consultation room.
6. The nurse loads the room and does a three to five-minute asymmetry exam, and then returns to the original room and does the last three to five minutes of the appointment after the doctor prioritizes the veterinary healthcare delivery plan.
7. See samples attached.
Foci scheduling, from the "E" (emergency) block
Date______________________ Day_____________________ |
|
Exam #1 Doctor:____________________ Nurse:_______________ Exam #2 |
Time |
Client |
Patient |
Concern |
Phone |
Time |
Client |
Patient |
Concern |
Phone |
7:55 |
|
|
|
|
7:55 |
|
|
|
|
8:05 |
|
|
|
|
8:05 |
|
|
|
|
8:15 |
|
|
|
|
8:15 |
|
|
|
|
8:25 |
|
dog |
an.vac |
|
8:25 |
|
|
|
|
8:35 |
|
|
|
|
8:35 |
|
|
|
|
8:45 |
|
|
|
|
8:45 |
|
2 cats |
annual |
|
8:55 |
|
dog |
sick |
|
8:55 |
|
|
|
|
9:05 |
|
|
|
|
9:05 |
|
cat |
vac |
|
9:15 |
|
|
|
|
9:15 |
|
|
|
|
9:25 |
|
|
|
"E" |
9:25 |
|
|
|
"E" |
9:35 |
New |
dog |
Annual |
|
9:35 |
|
|
|
|
9:45 |
|
|
|
|
9:45 |
|
|
|
|
9:55 |
|
|
|
|
9:55 |
|
cat |
sick |
|
10:05 |
|
Cat |
Recheck |
|
10:05 |
|
|
|
|
10:15 |
|
|
|
|
10:15 |
|
|
|
|
Effective start for one doctor practice, since doctor will maximize open mid-day time for inpatient cases
Date: ___________________ Day: _____________________ |
|
Exam #1 Doctor:____________________ Nurse:_______________ Exam #2 |
Time |
Client |
Patient |
Concern |
Phone |
Time |
Client |
Patient |
Concern |
Phone |
7:55 |
New |
dog |
annual |
|
7:55 |
|
|
|
|
8:05 |
|
|
|
|
8:05 |
|
|
|
|
8:15 |
|
|
|
|
8:15 |
|
cat |
sick |
|
8:25 |
|
dog |
vac |
|
8:25 |
|
|
|
|
8:35 |
|
|
|
|
8:35 |
|
2 dog |
vac |
|
8:45 |
|
|
|
|
8:45 |
|
|
|
|
8:55 |
|
|
|
|
8:55 |
|
|
|
|
9:05 |
|
|
|
|
9:05 |
|
|
|
|
9:15 |
|
|
|
|
9:15 |
|
|
|
|
9:25 |
|
|
|
"E" |
9:25 |
|
|
|
"E" |
9:35 |
|
|
|
|
9:35 |
|
|
|
|
9:45 |
|
|
|
|
9:45 |
|
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9:55 |
|
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9:55 |
|
|
|
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10:05 |
|
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10:05 |
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10:15 |
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10:15 |
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|
This format requires a very skilled client relations staff to "fill the gap" early morning, before scheduling clients into later slots in the morning.
Date: ______________________ Day: ______________________ |
|
Exam #1 Doctor:____________________ Nurse:_______________ Exam #2 |
Time |
Client |
Patient |
Concern |
Phone |
Time |
Client |
Patient |
Concern |
Phone |
7:55 |
New |
dog |
annual |
|
7:55 |
|
|
|
|
8:05 |
|
|
|
|
8:05 |
|
|
|
|
8:15 |
|
|
|
|
8:15 |
|
cat |
sick |
|
8:25 |
|
|
|
|
8:25 |
|
|
|
|
8:35 |
|
|
|
|
8:35 |
|
|
|
|
8:45 |
|
|
|
|
8:45 |
|
|
|
|
8:55 |
|
|
|
|
8:55 |
|
|
|
|
9:05 |
|
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9:05 |
|
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|
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9:15 |
|
|
|
|
9:15 |
|
|
|
|
9:25 |
|
|
|
"E" |
9:25 |
|
|
|
"E" |
9:35 |
|
cat |
vac |
|
9:35 |
|
|
|
|
9:45 |
|
|
|
|
9:45 |
|
dog |
vac |
|
9:55 |
|
dog |
sic |
|
9:55 |
|
|
|
|
10:05 |
|
|
|
|
10:05 |
Two |
dogs |
(10 min) |
|
10:15 |
|
|
|
|
10:15 |
|
|
|
|
High-Density Schedule Sample
Date: _______________________ Day: _____________________ |
|
Exam #1 Doctor:____________________ Nurse:_______________ Exam #2 |
Time |
Client |
Patient |
Concern |
Phone |
Time |
Client |
Patient |
Concern |
Phone |
7:55 |
Two |
dog |
annual |
|
7:55 |
|
|
|
|
8:05 |
|
|
|
|
8:05 |
|
|
|
|
8:15 |
|
|
|
|
8:15 |
|
cat |
sick |
|
8:25 |
|
dog |
vac |
|
8:25 |
|
|
|
|
8:35 |
|
|
|
|
8:35 |
Two |
dog |
vac |
|
8:45 |
|
|
|
|
8:45 |
|
|
|
|
8:55 |
|
cat |
sick |
|
8:55 |
|
|
|
|
9:05 |
|
|
|
|
9:05 |
|
dog |
annual |
|
9:15 |
|
|
|
|
9:15 |
|
|
|
|
9:25 |
|
|
|
"E" |
9:25 |
|
|
|
"E" |
9:35 |
|
cat |
sick |
|
9:35 |
|
|
|
|
9:45 |
|
|
|
|
9:45 |
|
dog |
vac |
|
9:55 |
|
|
|
|
9:55 |
|
|
|
|
10:05 |
|
|
|
|
10:05 |
|
|
|
|
10:15 |
|
|
|
|
10:15 |
|
|
|
|
Ten patients in two hours. And no one gets less than twenty minutes! Please note the sixty minutes of nursing "catch-up" time in that two hours. Nurse catch-up time can also be suture removal, sequential lab blood draws, etc.
Date: _______________________ Day: _____________________ |
|
Exam #1 Doctor:____________________ Nurse:_______________ Exam #2 |
Time |
Client |
Patient |
Concern |
Phone |
Time |
Client |
Patient |
Concern |
Phone |
7:55 |
Two |
dog |
annual |
|
7:55 |
|
|
|
|
8:05 |
|
|
|
|
8:05 |
|
|
|
|
8:15 |
|
|
|
|
8:15 |
|
|
|
|
8:25 |
|
dog |
vac |
|
8:25 |
|
|
|
|
8:35 |
|
|
|
|
8:35 |
|
|
|
|
8:45 |
|
cat |
sick |
|
8:45 |
|
|
|
|
8:55 |
|
|
|
|
8:55 |
|
|
|
|
9:05 |
|
dog |
annual |
|
9:05 |
|
|
|
|
9:15 |
|
|
|
|
9:15 |
|
|
|
|
9:25 |
|
|
|
"E" |
9:25 |
|
|
|
"E" |
9:35 |
Two |
cats |
sick |
|
9:35 |
|
|
|
|
9:45 |
|
|
|
|
9:45 |
|
|
|
|
9:55 |
|
|
|
|
9:55 |
|
|
|
|
10:05 |
|
|
|
|
10:05 |
|
|
|
|
10:15 |
|
|
|
|
10:15 |
|
|
|
|
Plan#1: Fill one exam room column per doctor on outpatient.
Expanded: Go to high-density, when shift is full for one room. Schedule second room. Concern: Last ten minutes in one room overlaps with first ten minutes in second room.
Notification: High-density schedule requires technician nurse alert.
Additional: Pharmacy float person will be important technician assistant.
Note: If full, inpatient doctor comes forward to take walk-ins and emergencies.
Plan #2: Fill one room and can't do second, due to doctor speed limitations.
Alternative: Inpatient doctor takes walk-ins, as well as emergencies in other room.
Alternative "Balanced" Staffing Schedule Draft
|
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
Dr. #1 |
7-5 |
11-8 |
off |
7-5 |
7-7 |
7-2 |
off |
10-7 |
7-5 |
7-7 |
11-8 |
off |
off |
off |
Dr. #2 |
10-7 |
7-5 |
7-7 |
11-8 |
off |
off |
off |
7-5 |
11-8 |
off |
7-5 |
7-7 |
7-2 |
off |
General Considerations
Schedules done six weeks ahead, swaps preferred over rotation changes. Flexibility is based on season, doctor skills, and caseload, but not on type of case. Transfer of cases from outpatient to inpatient is the rule and alternative systems are by exception only.
10:00/11:00 a.m. doctor is inpatient with drop-off, walk-in, and emergency with 10:00/11:00 a.m. technician. Back-front float.
This doctor starts three-case surgery load by 11:00 a.m. Reverts to outpatient at 1:00 p.m. until close.
7:00 a.m. doctor is on-line by 7:30 a.m. morning outpatient with 7:00 outpatient nurse. Two exam rooms out of phase.
The afternoon outpatient doctor is also by "high-density scheduling" of rooms, not doctors.
Elective surgery: M, Tu, and Th. Cases prioritized by doctors on treatment room board in early a.m.
10:00/11:00 a.m. doctor starts surgery at 11:00 a.m. and out by 1:00 p.m. Reverts to outpatient at 1:00 p.m. until close. Food break at about 4:00 p.m. is scheduled into appointment book.
7:00 a.m. doctor becomes outpatient doctor on arrival, then does inpatient/surgery after 1:00 p.m. in afternoon. For example, lunch at 1:00 p.m., surgery catch-up, then inpatient and telephone from 2:00 to 5:00 p.m.
Non-elective surgery: W and F. Done mid-day during slow times.
Dentistries done daily by nursing staff.
Same "Hate Mornings" Staffing Schedule Draft
|
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
Dr. New |
off |
11-8 |
off |
11-8 |
7-7 |
7-3 |
off |
off |
11-8 |
off |
11-8 |
7-7 |
7-3 |
off |
Dr. Old |
7-7 |
7-5 |
7-7 |
7-5 |
off |
off |
off |
7-7 |
7-5 |
7-7 |
7-5 |
off |
off |
off |
General Considerations
Schedules done six weeks ahead, swaps preferred over rotation changes .Flexibility is based on season, doctor skills, and caseload, but not on type of case. Transfer of cases from outpatient to inpatient is the rule and alternative systems are by exception only.
7:00 a.m. doctor is on-line by 7:30 a.m., morning outpatient with 7:00 a.m. outpatient nurse. Two exam rooms out of phase. The afternoon outpatient doctor is also by "high-density scheduling" of rooms, not doctors.
7:00 a.m. doctor becomes outpatient doctor on arrival, but could do inpatient/surgery after 1:00 p.m. in afternoon. For example, lunch at 1:00 p.m., surgery catch-up, then inpatient and telephone from 2:00 to 5:00 p.m.
11:00 a.m. doctor is inpatient, with drop-off, walk-in, and emergency with 10:00 a.m. technician. Back-front float
This doctor starts spay/neuter surgery load Noon to 3:00 p.m. Reverts to outpatient at 4:00 p.m. until close.
Elective surgery: Tu and Th. Cases prioritized by doctors on treatment room board at 11:00 a.m. 11 a.m. doctor starts pet population control surgery at Noon and is out by 3:00 p.m. Reverts to outpatient at 4:00 p.m. until close. Food break at about 3:00 p.m. is scheduled into appointment book.
Non-elective surgery: W and F. Done mid-day during slow times.
Dentistries done daily by nursing staff. Grades 1 and 2, while doctor is on outpatient. Grades 3 and 4, when inpatient doctor is available.
Sample Three-week Staffing Schedule
Code Key
12-8 |
Doctor has surgery until 3:00 p.m., meal/phone 3:00-4:00, then 4:00-8:00 outpatients appointments, then overnight call. |
8-4 |
Doctor has outpatient to 1:00 p.m., then lunch and inpatient cleanup until 4:00 p.m. |
9-6 |
Doctor has inpatient (walk-ins, emergency, inpt tx, elective surgery etc.), Noon lunch, and outpatient 1:00-6:00 p.m. bold is ambulatory on call; A-5 doctor has ambulatory in morning, has flexible care/overflow in afternoon. |
8-2 |
Doctor is Saturday outpatient |
Staggered DVM meal hours. No door lock. Extended evening hours. Staffed anyway. |
Dr. #1 |
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
8-4 |
8-4 |
12-8 |
off |
8-4 |
8-2 |
off |
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
Off |
Off |
12-8 |
8-4 |
8-4 |
off |
off |
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
8-4 |
8-4 |
12.8 |
Off |
8-4 |
off |
off |
Dr. #2 |
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
off |
A-5 |
off |
12-8 |
A-5 |
off |
off |
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
A-5 |
A-5 |
off |
12-8 |
A-5 |
off |
off |
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
off |
A-5 |
A-5 |
12-8 |
A-5 |
8-2 |
off |
Dr. #3 |
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
A-5 |
12-8 |
A-5 |
A-5 |
Off |
off |
off |
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
9-6 |
12-8 |
A-5 |
A-5 |
Off |
8-2 |
off |
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
A-5 |
12-8 |
Off |
A-5 |
12-8 |
off |
off |
Dr. PT |
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
9-6 |
Off |
8-4 |
8-4 |
12-8 |
off |
off |
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
8-4 |
8-4 |
8-4 |
Off |
12-8 |
off |
off |
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
9-6 |
Off |
8-4 |
8-4 |
off |
off |
off |
Premises
Doctor and nurse pairs in paired exam rooms - one technical assistant float in lab pharmacy whether one or two teams.
Travel sheet has 3Rs. Start one every time a client arrives.
Doctor works with one nurse, never pulls another. Two rooms out of sync and doctor pace is controlled by nurse.
The following are inpatient cases: X-ray, laboratory, ear flushing, tails, IV fluids, etc. Receptionist keeps doctor schedules filled, shifting walk-ins and appointments between doctors to keep wait time down.
Appointments stay within ten-minutes of target (promised) times. Receptionist and nurse accountability.
Receptionist puts ready records into rack in reception. Do not leave the front area.
The outpatient nurse technician moves the records and clients from reception to exam to reception/discharge
After healthcare is prioritized by doctor, the inpatient or outpatient nurse technician can do exam room discharges.
Discharge invoicing from the travel sheet requires entry of 3 Rs for next visit by nurse.
Requirements
Better continuity of care in medical records[ ] = need, W-D-A-X is client response inside box).
High-density scheduling.
Start training doctor-nursing staff immediately and start "test periods" to see how teams work.
Outpatient nurse technician training centers on three-to-five-minute asymmetry check, without diagnostics or doctor talk
Increased nursing telephone surveillance for symptomatic and deferred care
Doctors respect staff, staff keeps them on schedule (social contract with clients).
Always -- No Blame -- No Yelling -- No Public Negatives -- Just CQI
Sample Three-Week Staffing Schedule
Code Key
Surg |
Ready by 9:00 a.m. Cut until 1:00. Elective cases. Nurse admits until 9:00 a.m., doctor prioritizes on white board, then cut until done. |
12-8 |
Doctor has surgery until 3:00 p.m., meal/phone 3:00-4:00, then 4:00-8:00 outpatients appointments, then overnight call. |
12-7 |
Doctor has inpatient first, then outpatient 3:00-7:00 p.m. |
FLT |
Shift relief and swap for other doctors, as needed. |
8-4 |
Doctor has outpatient 8:30 a.m. to Noon, then inpatient clean up until 4:00 p.m. |
9-5 |
Doctor has inpatient (walk-ins, emergency, inpt tx, elective surgery etc.) and outpatient 1:00-5:00 p.m. |
F-5 |
Doctor has cleanup from weekend, has outpatient overflow to Noon, then inpatient until 4:00 p.m. |
F-C |
Doctor is Friday night on-call to Sunday 8:00 a.m., with Saturday 8:00-6:00 outpatient/inpatient float. |
8-2 |
Doctor is Saturday outpatient, then assumes call at 8:00 a.m. Sunday until 8:00 a.m. Monday. |
Staggered DVM meal hours. No door lock. Extended evening hours. Staffed anyway |
Dr. ? |
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
12-8 |
Off |
8-4 |
9-5 |
Off |
Off |
Off1 |
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
8-4 |
9-5 |
12-8 |
8-4 |
Off |
8-2 |
call |
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
F-5 |
12-8 |
Off |
8-4 |
9-5 |
F-C |
off |
Dr. A |
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
F-5 |
12-8 |
Off |
FLT |
9-5 |
F-C |
off |
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
12-8 |
Off |
8-4 |
FLT |
off |
off |
off |
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
8-4 |
9-5 |
12-8 |
FLT |
Off |
8-2 |
call |
Dr. N |
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
8-4 |
9-5 |
12-8 |
8-4 |
Off |
8-2 |
call |
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
F-5 |
12-8 |
Off |
9-5 |
9-5 |
F-C |
off |
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
12-8 |
Off |
8-4 |
9-5 |
off |
off |
off |
Dr. JS |
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
Off |
Surg |
9-5 |
123-7 |
12-8 |
off |
off |
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
Off |
Surg |
9-5 |
12-7 |
12-8 |
off |
off |
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
Off |
Surg |
9-5 |
12-7 |
12-8 |
off |
off |
Dr. LB |
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
Surg |
8-4 |
FLT |
12-8 |
8-4 |
off |
off |
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
off |
Surg |
FLT |
12-8 |
8-4 |
off |
off |
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
Surf |
8-4 |
FLT |
12-8 |
8-4 |
off |
off |
Premises
Doctor and nurse pairs in paired exam rooms. One technical assistant float in lab pharmacy whether one or two teams.
Travel sheet has 3Rs. Start one every time a client arrives.
Doctor works with one nurse, never pulls another. Two rooms out of sync and doctor pace is controlled by nurse.
The following are in-patient cases: X-ray, laboratory, ear flushing, tails, IV fluids, etc.
Receptionist keeps doctor schedules filled, shifting walk-ins and appointments between doctors to keep wait time down.
Appointments stay within ten-minutes of target (promised) times. Receptionist and nurse accountability
Receptionist puts ready records into rack in reception. Do not leave the front area.
The outpatient nurse technician moves the records and clients from reception to exam to reception/discharge.
After healthcare is prioritized by doctor, the inpatient or outpatient nurse technician can do exam room discharges.
Discharge invoicing from the travel sheet requires entry of 3Rs for next visit by nurse.
Requirements
Better continuity of care in medical records.
High-density scheduling.
Start training doctor-nursing staff immediately and start "test periods" to see how teams work.
Outpatient nurse training centers on three-to-five-minute asymmetry check without diagnostics or doctor talk.
Alternative Staffing Schedule
Code Key
o = outpatient (two exam rooms with nurse technician) |
am = a.m. = 7:30 a.m.-1:00 p.m. |
I = inpatient/float |
pm = p.m. = Noon-6:00 p.m. |
surg = surgery case load - back-up for inpatient doctor |
nt = nights = 4:00 p.m.-Midnight |
rot = rotation = long-term weekend schedule |
gy = graveyard = 11:00 p.m.-9:00 a.m. |
sat = satellite clinical duty |
|
|
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
Dr. J.S |
surg |
surg |
surg |
surg |
off |
off |
off |
Surg |
Surg |
Surg |
Surg |
off |
off |
off |
Dr. D.C |
off |
o-am |
o-am |
Sat |
Sat |
off |
off |
off |
o-am |
o-am |
Sat |
Sat |
off |
off |
Dr. #1 |
o-am
l-pm |
o-nt |
gy |
off |
Surg |
Rot |
Rot |
o-am
l-pm |
I-nt |
o-nt |
o-nt |
o-am |
rot |
rot |
Dr. #2 |
l-am
o-pm |
o-am
I-pm |
o-nt |
Gy |
Off |
rot |
rOT |
surg |
o-am
l-pm |
o-nt |
l--nt |
o-am
surg |
rot |
rot |
Dr. #3 |
o-am |
l-am
o-pm |
o-nt |
o-am
o-pm |
gy |
rot |
rot |
l-am
o-pm |
Surg |
l-nt |
o-nt |
l-nt |
rot |
rot |
Dr. #4 |
surg |
sat |
sat |
o-nt |
o-nt |
rot |
rot |
l-nt |
sat |
sat |
gy |
off |
rot |
rot |
Dr. #5 |
l-nt |
o-nt |
sat |
sat |
o-am
o-pm |
rot |
rot |
o-nt |
l-am
o-pm |
sat |
sat |
gy |
rot |
rot |
Dr. #6 |
o-pm |
Gy |
Off |
o-nt |
o-nt |
rot |
rot |
o-am |
o-nt |
gy |
off |
surg |
rot |
rot |
Dr. #7 |
o-nt |
surg |
l-nt |
l-am
surg |
o-am
l-pm |
rot |
rot |
l-am
o-pm |
gy |
off |
o-am
o-pm |
o-nt |
rot |
rot |
Dr. #8 |
o-nt |
l-nt |
o-am
o-pm |
l-nt |
Surg |
rot |
rot |
gy |
Off |
o-am
surg |
o-am
surg |
o-nt |
rot |
rot |
Dr. #9 |
gy |
off |
l-am
surg |
o-am
l-pm |
l-nt |
rot |
rot |
o-nt |
o-nt |
l-am
o-pm |
l-am
surg |
o-nt |
rot |
rot |
Dr. #10 |
sat |
sat |
off |
off |
sat |
sat |
rot |
sat |
sat |
off |
off |
sat |
sat |
rot |
Less than Optimum Staffing Schedule
Code Key
o = outpatient (two exam rooms with nurse technician) |
am = a.m. = 7:30 a.m.-1:00 p.m. |
I = inpatient/float/front fill |
pm = p.m. = Noon-6:00 p.m. |
surg = surgery case load - back-up for inpatient doctor |
nt = nights = 4:00 p.m.-Midnight |
rot = rotation = long-term weekend schedule |
gy = graveyard = 11:00 p.m.-9:00 a.m. |
sat = satellite clinical duty |
|
|
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
Mon |
Tues |
Wed |
Thur |
Fri |
Sat |
Sun |
Dr. J.S. |
surg |
surg |
surg |
surg |
Mgmt |
off |
off |
Surg |
Surg |
Surg |
Surg |
Mgmt |
off |
off |
Dr. D.C. |
o-am surg |
Mgmt |
Sat |
o-am o-pm |
Sat |
off |
off |
o-am surg |
Mgmt |
Sat |
surg
o-pm |
Sat |
off |
off |
Dr. #1 |
l-am o-pm |
gy |
I-nt |
Surg |
o-am
o-pm |
Rot |
Rot |
l-am
o-pm |
o-am
I-pm |
Surg |
gy |
I-nt |
rot |
rot |
Dr. #2 |
o-am
I-pm |
Surg |
gy |
l-nt |
I-am
Surg |
rot |
rot |
o-am I-pm |
Surg |
gy |
I-nt |
I-am Surg |
rot |
rot |
Dr. #3 |
Surg |
l-am
o-pm |
o-am
I-pm |
gy |
I-nt |
rot |
rot |
I-nt |
I-am
Surg |
o-am
I-pm |
o-am |
gy |
rot |
rot |
Dr. #4 |
gy |
o-nt |
sat |
sat |
Surg
I-pm |
rot |
rot |
gy |
o-nt |
sat |
sat |
Surg
I-pm |
rot |
rot |
Dr. B.G. |
o-nt |
l-nt |
6-9 |
o-nt |
off |
rot |
rot |
o-nt |
I-nt |
6-9 |
o-nt |
off |
rot |
rot |
Dr. A.B. |
I-nt |
o-am |
I-am
I-pm |
Sat Surg |
gy Surgt |
rot |
rot |
Surg |
gy |
I-nt |
sat |
o-am |
rot o-pm |
rot |
*This schedule attempts to balance the shifts and the special needs previously committed. Inherent in the transfer of cases at the end of shift is the continuity of care requirements (need =[ ], with client response and time delay for any "W" or "D" entries). On-coming doctor must release off-going doctor after case transferred.
Sample Weekend Rotation
|
Saturday
7 a.m.-2 p.m. |
Saturday
7 a.m.-7 p.m. |
Sat-Sunday
7 p.m.-7 a.m. |
Sunday
7 a.m.-7 p.m. |
Sun-Monday
7 p.m.-9 a.m. |
Dr. #1 |
Weekend #1 |
Weekend #3 |
Weekend #5 |
Weekend #7 |
Weekend #9 |
Dr. #2 |
Weekend #2 |
Weekend #4 |
Weekend #6 |
Weekend #8 |
Weekend #10 |
Dr. #3 |
Weekend #3 |
Weekend #5 |
Weekend #7 |
Weekend #9 |
Weekend #1 |
Dr. #4 |
Weekend #4 |
Weekend #6 |
Weekend #8 |
Weekend #10 |
Weekend #2 |
Dr. #5 |
Weekend #5 |
Weekend #7 |
Weekend #9 |
Weekend #1 |
Weekend #3 |
Dr. #6 |
Weekend #6 |
Weekend #8 |
Weekend #10 |
Weekend #2 |
Weekend #4 |
Dr. #7 |
Weekend #7 |
Weekend #9 |
Weekend #1 |
Weekend #3 |
Weekend #5 |
Dr. #8 |
Weekend #8 |
Weekend #10 |
Weekend #2 |
Weekend #4 |
Weekend #6 |
Dr. #9 |
Weekend #9 |
Weekend #1 |
Weekend #3 |
Weekend #5 |
Weekend #7 |
Dr. #10 |
Weekend #10 |
Weekend #2 |
Weekend #4 |
Weekend #6 |
Weekend #8 |
Or When Understaffed: |
|
Saturday
7 a.m.-2 p.m. |
Saturday
7 a.m. -7 p.m. |
Sat-Sunday
7 p.m.-7 a.m. |
Sunday
7 a.m.-7 p.m. |
Sun-Monday
7 p.m.-9 a.m. |
Dr. #1 |
Weekend #2 |
Weekend #3 |
Weekend #4 |
Weekend #5 |
Weekend #6 |
Dr. #2 |
Weekend #4 |
Weekend #5 |
Weekend #6 |
Weekend #1 |
Weekend #2 |
Dr. #3 |
Weekend #1 |
Weekend #2 |
Weekend #3 |
Weekend #4 |
Weekend #5 |
Dr. #4 |
Weekend #3 |
Weekend #4 |
Weekend #5 |
Weekend #6 |
Weekend #1 |
Dr. #5 |
Weekend #5 |
Weekend #6 |
Weekend #1 |
Weekend #2 |
Weekend #3 |
Dr. #6 |
Weekend #6 |
Weekend #1 |
Weekend #2 |
Weekend #3 |
Weekend #4 |
Staff Schedules
Monday |
Receptionist |
Time |
Outpatient Nurse Tech |
Time |
Inpatient Nurse Tech |
recept 7-Noon |
|
8-Noon |
|
8-1 |
|
recept 8-Noon |
|
8-Noon |
|
Noon-4 |
|
recept 8-Noon |
|
Noon-4 |
|
4-8 |
|
recept Noon-4 |
|
3-7 |
|
|
InPt tech Asst/Anctkr |
recept Noon-4 |
|
4-9 |
|
6-2 |
|
recept 4-8 |
|
|
Outpt Tech Asst |
2-9 |
|
recept 4-8 |
|
8-Noon |
|
|
Surg Tech |
recept 4-9 |
|
Noon-4 |
|
8-4 |
|
phone 8-Noon |
|
4-9 |
|
|
|
phone 4-8 |
|
|
|
|
|
Tuesday |
Receptionist |
Time |
Outpatient Nurse |
Time |
Inpt Nurse |
recept 7-Noon |
|
8-Noon |
|
8-1 |
|
recept 8-Noon |
|
8-Noon |
|
Noon-4 |
|
recept 8-Noon |
|
Noon-4 |
|
4-8 |
|
recept Noon-4 |
|
3-7 |
|
|
InPt tech Asst/Anctkr |
recept Noon-4 |
|
4-9 |
|
6-2 |
|
recept 4-8 |
|
|
Outpt Tech Asst |
2-9 |
|
recept 4-8 |
|
8-Noon |
|
|
Surg Tech |
recept 4-9 |
|
Noon-4 |
|
8-4 |
|
phone 4-8 |
|
4-9 |
|
|
|
Wednesday |
Receptionist |
Time |
Outpatient Nurse Tech |
Time |
Inpatient Nurse Tech |
recept 7-Noon |
|
8-Noon |
|
8-1 |
|
recept 8-Noon |
|
8-Noon |
|
Noon-4 |
|
recept 8-Noon |
|
Noon-4 |
|
4-8 |
|
recept Noon-4 |
|
4-9 |
|
|
InPt tech Asst/Anctkr |
recept Noon-4 |
|
|
|
6-2 |
|
recept 4-8 |
|
|
Outpt Tech Asst |
2-9 |
|
recept 4-8 |
|
8-Noon |
|
|
|
recept 4-9 |
|
Noon-4 |
|
|
|
phone 4-8 |
|
4-9 |
|
|
|
Thursday |
Receptionist |
Time |
Outpatient Nurse |
|
Inpt Nurse |
recept 7-Noon |
|
8-Noon |
|
8-1 |
|
recept 8-Noon |
|
8-Noon |
|
Noon-4 |
|
recept 8-Noon |
|
Noon-4 |
|
4-8 |
|
recept Noon-4 |
|
3-7 |
|
|
InPt tech Asst/Anctkr |
recept Noon-4 |
|
4-9 |
|
6-2 |
|
recept 4-8 |
|
|
Outpt Tech Asst |
2-9 |
|
recept 4-8 |
|
8-Noon |
|
|
Surg Tech |
recept 4-9 |
|
Noon-4 |
|
11-5 |
|
phone 4-8 |
|
4-9 |
|
|
|
Friday |
Receptionist |
Time |
Outpatient Nurse Tech |
Time |
Inpatient Nurse Tech |
recept 7-Noon |
|
8-Noon |
|
8-1 |
|
recept 8-Noon |
|
Noon-4 |
|
Noon-4 |
|
recept 8-Noon |
|
4-9 |
|
4-8 |
|
recept Noon-4 |
|
|
|
|
InPt tech Asst/Anctkr |
recept Noon-4 |
|
|
|
6-2 |
|
recept 4-8 |
|
|
Outpt Tech Asst |
2-9 |
|
recept 4-8 |
|
8-Noon |
|
|
|
recept 4-9 |
|
Noon-4 |
|
|
|
phone 4-8 |
|
4-9 |
|
|
|
Saturday |
Receptionist |
Time |
Outpatient Nurse |
Time |
Inpt Nurse |
recept 7-2 |
|
7-3 |
|
8-1 |
|
recept 8-6 |
|
8-1 |
|
1-7 |
|
phone 8-1 |
|
1-6 |
|
|
|
|
|
|
|
|
InPt tech Asst/Anctkr |
|
|
|
|
6-2 |
|
|
|
|
Outpt Tech Asst |
1-8 |
|
|
|
7-Noon |
|
|
|
|
|
Noon-6 |
|
|
|
|
|
|
|
|
|