An optimal decision making model for supporting week hospital management

Abstract

Week Hospital is an innovative inpatient health care organization and management, by which hospital stay services are planned in advance and delivered on week-time basis to elective patients. In this context, a strategic decision is the optimal clinical management of patients, and, in particular, devising efficient and effective admission and scheduling procedures, by tackling different requirements such as beds' availability, diagnostic resources, and treatment capabilities. The main aim is to maximize the patient flow, by ensuring the delivery of all clinical services during the week. In this paper, the optimal management of Week Hospital patients is considered. We have developed and validated an innovative integer programming model, based on clinical resources allocation and beds utilization. In particular, the model aims at scheduling Week Hospital patients' admission/discharge, possibly reducing the length of stay on the basis of an available timetable of clinical services. The performance of the model has been evaluated, in terms of efficiency and robustness, by considering real data coming from a Week Hospital Rheumatology Division. The experimental results have been satisfactory and demonstrate the effectiveness of the proposed approach.

Scheduling the hospital-wide flow of elective patients

“…First, an aggregated approach is followed in which clinical activities are assigned to big bucket periods with a length of one day. This is similar to Vissers et al [57] and Conforti et al [12] and differs from the detailed scheduling approaches of Min and Yih [34] and Pham and Klinkert [39]. However, Vissers et al [57] decide on the admission date of patients only and assume for the latter a fixed schedule.…”

“…Second, in terms of a deterministic or stochastic approach, our paper follows the aggregated approaches of Vissers et al [57] and Conforti et al [12]. The problems are modelled as a deterministic MIP using expected values for resource demands of clinical activities, for recovery times and resource capacities.…”

“…Constraints (11) ensure that for each patient exactly one LOS is selected and the additional LOS decision variables are defined by (12). Table 4 provides an extension of the example in Table 3 where, additionally, we assume for patient 1 admission time window W σ 1 := {1, 2, 3}.…”

Integrated decision making in healthcare : an operations research and management science perspective

“…The appointment series have to fit in the existing appointment schedules, which are partly filled with already scheduled appointments. Examples of patients that require appointment series are radiotherapy patients [109,110,111] and rehabilitation patients [100]. Methods: heuristics [100,397,509], Markov processes [230,391,509], mathematical programming [109,110,111].…”

“…Governing the rules set by tactical admission control policies, on the operational decision level the admission scheduling determines for a specific elective patient the time and date of admission. We found one reference on this decision: [111] presents a scheduling approach to schedule admissions for a short-stay inpatient facility that only operates during working days, which takes into account various resource availabilities such as beds and diagnostic resources. We suggest two reasons for the lack of contributions on this decision.…”