Sarah Root

Scheduling Medical Residents at Boston University School of Medicine

The chief residents in the psychiatry program at Boston University School of Medicine (BUSM) must construct a schedule that simultaneously assigns residents to five types of call shifts, spanning three different hospitals, over a 365-day planning horizon. We show how user expertise and heuristic approaches alone fail to find acceptable solutions to this complex combinatorial problem; likewise, mathematical programming techniques alone are inadequate, largely because they lack a clearly definable objective function. However, by combining both approaches, we were able to find high-quality solutions in a very short time. The resulting schedule, which BUSM uses currently, has yielded substantial benefits; the solution quality has improved, and the effort required to develop the solution has been reduced.

Integration of the Load-Matching and Routing Problem with Equipment Balancing for Small Package Carriers

Small package delivery is a multibillion dollar industry with complex planning decisions required to efficiently utilize costly resources and meet tight time requirements. The planning process is typically decomposed into sequential subproblems to establish tractability. This decomposition can greatly degrade solution quality. This paper therefore considers the integration of two closely related key subproblems: load matching and routing and equipment balancing. First, we identify critical challenges faced in trying to solve these problems. Then we present a novel modeling approach to address these challenges. Finally, we conclude with computational results from United Parcel Service, the worlds largest package delivery company, demonstrating an improvement of approximately 5% over the companys existing methods for solving this pair of problems.

Consumer-Driven Healthcare: Information, Incentives, Enrollment, and Implications for National Health Expenditures

We highlight the importance of information for consumerdriven healthcare (CDHC), describe barriers, display data on adoption rates and product features, and use a new health modeling approach to investigate the potential impact on national healthcare expenditures. We conclude with an assessment of the prospects for CDHC as a revolution of information, competition, and market orientation; and we discuss potential pitfalls, including concern regarding vulnerable populations. While the jury is out on the ultimate effects, enrollment in CDHC programs—while still small—is growing rapidly; utilization and costs for subscribers appear to be moderating; and creative benefit structures emphasize health promotion alongside previously unseen cost consciousness.

Survey of Hospital Pharmacy Directors: Assessment of the Current State of Unit-Dose Acquisition

Background: Many hospitals are in the planning stage of barcode point-of-care (BPOC) implementation. One of the challenges that hospital pharmacies face in BPOC implementation is unit-dose acquisition. Objective: This article presents the results of a survey of hospital pharmacy directors to assess the current state of unit-dose acquisition to support bedside barcode-enabled dispensing practices. Methods: An online survey was administered over 2 months and was available from September to November 2008. The University of Arkansas Institutional Review Board approved the survey before it was disseminated. The survey was developed in collaboration with 2 hospital pharmacy directors. Ninety-one valid survey responses were representative in terms of the distribution of hospital size compared with previous surveys of the American Society of Health-System Pharmacists. Though there were 91 total respondents, not all provided responses to all of the survey questions. Thus, some of the figures, tables, and text refer to fewer than 91 respondents. Results: The results of interest to pharmacy technicians indicated that most hospitals today are able to purchase at least 40% of their medications in unit-dose packaging directly from the manufacturer. For medications that cannot be acquired in unit-dose packaging, 85% of the hospitals surveyed perform repackaging operations in-house. However, 87% of the hospitals that use a high-speed oral solid repackager only use this equipment, at most, 4 hours per day. Our survey results showed that only 8% of the hospitals surveyed used a third-party repackager to acquire unit-dose medications, compared with 85% of hospitals that are either currently using or in the planning phase of using BPOC. Conclusions: The survey found that most hospital pharmacy directors choose to repackage medications in-house, despite the high cost of repackaging equipment and a relatively low utilization of that equipment. Hospitals indicated that cost and turnaround time were the 2 issues of greatest concern when considering outsourcing unit-dose medication repackaging to a third-party repackager.

Third-party repackaging in hospital pharmacy unit dose acquisition.

Medication errors can occur during every step of the medication-use process, but they occur most frequently during the prescribing and administration stages.[1][1] In fact, “when all types of errors are taken into account, a hospital patient can expect on average to be subjected to more than one

Supply chain design considering correlated failures and inspection in pharmaceutical and food supply chains

Abstract This paper studies the impact of correlated supplier failures as well as inspection to detect these failures in the context of a supplier selection problem. A two-stage stochastic programming model is developed to explore the tradeoffs between costs and risk when designing a supply network. The first-stage decisions include the strategic decisions of determining which suppliers should be selected considering suppliers location and capacity while in the second stage, operational decisions related to transportation and inspection are determined. Several computational results are presented examining the effect of supplier correlation and inspection on supplier selection, transportation, and inspection strategies. A sensitivity analysis is also performed to explain the effect of key parameters on expected total cost and expected cost of shipped tainted materials.

Selecting And Allocating Repackaging Technology For Unit-Dose Medications In Hospital Pharmacies

To increase patient safety and support bedside-point-of-care medication administration, millions of unit-dose medications are dispensed in hospitals and health systems daily. Because not all medications are available in unit-dose form directly from the manufacturer, hospitals must repackage medications in unit-dose form themselves. We develop a mathematical model that simultaneously determines which level of technology is warranted and how each medication that is not delivered to the pharmacy in unit-dose form should be repackaged subject to multiple constraints. This model has been integrated into a free Excel-based tool available to pharmacy directors. We test our model with data based on small, medium, and large hospitals and conduct sensitivity analyses to gain further insight. We illustrate how the results from our model can aid in incorporating qualitative aspects into technology selection. Our results show that a semi-automated repackaging system is the most economical technology alternative for most hospital pharmacy in-house repackaging operations. This result, however, is sensitive to the number of unit-dose medications to repackage and the available labor.