Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente, P.O. Box 217, 7500, AE, Enschede, the Netherlands.
UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands.
Health Care Manag Sci. 2019 Mar;22(1):53-67. doi: 10.1007/s10729-017-9422-6. Epub 2017 Nov 9.
Scheduling appointments in a multi-disciplinary clinic is complex, since coordination between disciplines is required. The design of a blueprint schedule for a multi-disciplinary clinic with open access requirements requires an integrated optimization approach, in which all appointment schedules are jointly optimized. As this currently is an open question in the literature, our research is the first to address this problem. This research is motivated by a Dutch hospital, which uses a multi-disciplinary cancer clinic to communicate the diagnosis and to explain the treatment plan to their patients. Furthermore, also regular patients are seen by the clinicians. All involved clinicians therefore require a blueprint schedule, in which multiple patient types can be scheduled. We design these blueprint schedules by optimizing the patient waiting time, clinician idle time, and clinician overtime. As scheduling decisions at multiple time intervals are involved, and patient routing is stochastic, we model this system as a stochastic integer program. The stochastic integer program is adapted for and solved with a sample average approximation approach. Numerical experiments evaluate the performance of the sample average approximation approach. We test the suitability of the approach for the hospital's problem at hand, compare our results with the current hospital schedules, and present the associated savings. Using this approach, robust blueprint schedules can be found for a multi-disciplinary clinic of the Dutch hospital.
在多学科诊所中安排预约是复杂的，因为需要协调不同学科之间的工作。为具有开放访问要求的多学科诊所设计蓝图时间表需要采用综合优化方法，其中所有预约时间表都需要共同优化。由于这在文献中是一个悬而未决的问题，因此我们的研究首次解决了这个问题。这项研究的动机来自一家荷兰医院，该医院使用多学科癌症诊所来与患者沟通诊断结果，并向他们解释治疗计划。此外，临床医生还会为定期就诊的患者提供服务。因此，所有相关的临床医生都需要一份蓝图时间表，其中可以安排多种类型的患者。我们通过优化患者等待时间、临床医生空闲时间和临床医生加班时间来设计这些蓝图时间表。由于涉及多个时间间隔的调度决策，并且患者的路由是随机的，因此我们将该系统建模为随机整数规划问题。该随机整数规划问题采用样本平均逼近方法进行适应性和求解。数值实验评估了样本平均逼近方法的性能。我们测试了该方法对于手头的医院问题的适用性，将我们的结果与当前医院的时间表进行了比较，并展示了相关的节省。通过这种方法，可以为荷兰医院的多学科诊所找到稳健的蓝图时间表。
