Thomsen Mette Skovhus, Nørrevang Ole
Department of Medical Physics, Aarhus University Hospital, Aarhus C, Denmark.
Acta Oncol. 2009;48(2):251-8. doi: 10.1080/02841860802266680.
In Denmark, the waiting time from the ready-to-treat date to the first radiotherapy fraction is by national legislation guaranteed not to exceed 4 weeks. This guarantee has now been tightened for some specific diagnoses as it is required that e.g. intestinal and head and neck cancer patients have to be treated without unnecessary delays. Thus, patients with these tumour sites have to start radiotherapy treatment immediately after diagnosis, if it is their primary treatment modality. Previously, patients have been booked at the first empty time slot after their ready-to-treat date. Now, booking has to take the differentiated waiting times into account. To facilitate this, a model has been developed. It is used to manage the booking of patients, reserve accelerator capacity for patients with no waiting time and establish the waiting times for other patients.
The patients are divided into categories according to their waiting time guarantee and for each category a maximum waiting time is defined. The required daily accelerator capacity and average new starts rate for each waiting time category has been determined from the actual patient case-mix in the department. To account for variations in treatment capacity, a prospective daily accelerator capacity is set. Based on the prospective capacity, preparation times, maximum waiting times, and new starts rates, a maximum booking curve (MBC) and a lower limit curve (LLC) are derived. They show the daily maximum and minimum limits, respectively, for booking at future dates.
The method is evaluated by a retrospective analysis of actual number of appointments booked compared to the MBC and LLC in situations of both excessive workload and ineffective use of capacity.
The model represents a tool for effectively managing the capacity in a radiotherapy department with differentiated waiting times. It improves the transparency of the booking process and prospective waiting times can easily be derived on a daily basis.
在丹麦，根据国家立法，从可治疗日期到首次放疗分次的等待时间保证不超过4周。现在，针对一些特定诊断，这一保证已经收紧，因为要求例如肠道和头颈癌患者必须避免不必要的延误进行治疗。因此，这些肿瘤部位的患者如果放疗是其主要治疗方式，在诊断后必须立即开始放疗治疗。以前，患者会被安排在可治疗日期后的第一个空闲时段。现在，安排必须考虑到不同的等待时间。为便于此操作，已开发出一种模型。它用于管理患者的安排，为无等待时间的患者预留加速器容量，并确定其他患者的等待时间。
根据患者的等待时间保证将其分为不同类别，并为每个类别定义最长等待时间。根据科室实际患者病例组合确定每个等待时间类别的每日所需加速器容量和平均新开始治疗率。为考虑治疗能力的变化，设定一个前瞻性每日加速器容量。基于前瞻性容量、准备时间、最长等待时间和新开始治疗率，得出最大安排曲线（MBC）和下限曲线（LLC）。它们分别显示未来日期安排的每日最大和最小限制。
通过回顾性分析在工作量过大和能力利用低效情况下实际安排的预约数量与MBC和LLC的对比，对该方法进行评估。
该模型是一种有效管理放疗科室不同等待时间下容量的工具。它提高了安排过程的透明度，并且可以轻松地每天得出前瞻性等待时间。
