Huang Yu-Li, Bach Sarah M, Looker Sherry A
College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Center for Quality, University of Chicago Medical Center , Chicago, Illinois, USA.
Int J Health Care Qual Assur. 2019 Feb 11;32(1):59-70. doi: 10.1108/IJHCQA-10-2017-0187.
The purpose of this paper is to develop a chemotherapy scheduling template that accounts for nurse resource availability and patient treatment needs to alleviate the mid-day patient load and provide quality services for patients.
DESIGN/METHODOLOGY/APPROACH: Owing to treatment complexity in chemotherapy administration, nurses are required at the beginning, end and during treatment. When nurses are not available to continue treatment, the service is compromised, and the resource constraint is violated, which leads to inevitable delay that risks service quality. Consequently, an optimization method is used to create a scheduling template that minimizes the violation between resource assignment and treatment requirements, while leveling patient load throughout a day. A case study from a typical clinic day is presented to understand current scheduling issues, describe nursing resource constraints, and develop a constraint-based optimization model and leveling algorithm for the final template.
The approach is expected to reduce the variation in the system by 24 percent and result in five fewer chemo chairs used during peak hours. Adjusting staffing levels could further reduce resource constraint violations and more savings on chair occupancy. The actual implementation results indicate a 33 percent reduction on resource constraint violations and positive feedback from nursing staff for workload.
RESEARCH LIMITATIONS/IMPLICATIONS: Other delays, including laboratory test, physician visit and treatment assignment, are potential research areas.
ORIGINALITY/VALUE: The study demonstrates significant improvement in mid-day patient load and meeting treatment needs using optimization with a unique objective.
本文旨在开发一种化疗排程模板，该模板考虑护士资源可用性和患者治疗需求，以减轻中午时段的患者负担，并为患者提供优质服务。
设计/方法/途径：由于化疗给药过程中的治疗复杂性，在治疗开始、结束及过程中都需要护士。当没有护士可继续进行治疗时，服务就会受到影响，资源限制也会被违反，这会导致不可避免的延误，从而危及服务质量。因此，采用一种优化方法来创建一个排程模板，该模板可最大限度地减少资源分配与治疗需求之间的冲突，同时使全天的患者负担趋于均衡。本文呈现了一个典型门诊日的案例研究，以了解当前的排程问题，描述护理资源限制，并为最终模板开发基于约束的优化模型和均衡算法。
预计该方法可使系统中的变化减少24%，并使高峰时段使用的化疗椅减少五把。调整人员配置水平可进一步减少违反资源限制的情况，并在椅子占用方面节省更多费用。实际实施结果表明，违反资源限制的情况减少了33%，护理人员对工作量给予了积极反馈。
研究局限/启示：其他延误，包括实验室检查、医生问诊和治疗安排，都是潜在的研究领域。
原创性/价值：该研究表明，通过具有独特目标的优化，中午时段的患者负担有显著改善，且能满足治疗需求。
