Integrating nurse assignment in outpatient chemotherapy appointment scheduling
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Integrating nurse assignment in outpatient chemotherapy appointment scheduling Alireza F. Hesaraki1 · Nico P. Dellaert2 · Ton de Kok2 Received: 23 February 2019 / Accepted: 29 June 2020 © The Author(s) 2020
Abstract In outpatient chemotherapy, nurses administer the drugs in two steps. In the first few minutes of each appointment, a nurse prepares the patient for infusion (drug administration). During the remainder of the appointment, the patient is monitored by nurses and if needed taken care of. One nurse must be assigned to prepare the patient and set up the infusion device. However, a nurse who is not busy setting up may simultaneously monitor up to a certain number of patients who are already receiving infusion. The prescribed infusion durations are significantly different among the patients on a day at a clinic. We formulate this problem as a multi-criterion mixed integer program. The appointments should be scheduled with start times close to patients’ ready times, balanced workload among nurses, few nurse changes during appointments, and few nurse full-time equivalent (FTE) assigned to the schedule of the day. As the number of nurse FTEs is an output of the model rather than a fixed input, the clinic can use the nursing capacity more efficiently, i.e., with less labor cost. We develop a 3-stage heuristic for finding criterion points with the minimum weighted average deferring time of appointments for the minimum feasible number of nurse FTEs or a desired value above that. By not constraining the number of chairs or beds, we can find solutions with better (dominating) criterion points. Drug preparation, oncologist visit, and the laboratory test can be scheduled based on the drug administration appointment start time. Thus, the drug administration resources are efficiently used with desirable performance in taking the interests and requirements of various stakeholders into consideration: patients, nurses, oncologists, pharmacy, and the clinic. Keywords Health services · Integer programming · Multi-criterion · Optimization · Scheduling · Chemotherapy
* Alireza F. Hesaraki [email protected] Extended author information available on the last page of the article
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1 Introduction Cancer is the first cause of death in The Netherlands (CBS 2016) and the second cause of death in the European Union after circulatory system diseases. Over 1.29 million people died from cancer in the 28 European Union countries in 2013: 26% of total deaths—30% of total deaths in The Netherlands. According to the World Health Organization fact sheets, 8.8 million people died from cancer worldwide in 2015, and the annual economic cost of cancer in 2010 was estimated about US$1.6 trillion (WHO 2015). The International Agency for Research on Cancer forecasts about 24 million patients to have cancer in 2035 (IARC 2017). In modern medicine, chemotherapy is a common cancer treatment procedure next to surgery and radiotherapy. Chemotherapy drugs kill rapidly dividing cells, and cancerous ce
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