Improving chemotherapy infusion operations through the simulation of scheduling heuristics: a case study

Abstract

Over the last decade, chemotherapy treatments have dramatically shifted to outpatient services such that nearly 90% of all infusions are now administered outpatient. This shift has challenged oncology clinics to make chemotherapy treatment as widely available as possible while attempting to treat all patients within a fixed period of time. Historical data from a Veterans Affairs chemotherapy clinic in the United States and staff input informed a discrete event simulation model of the clinic. The case study examines the impact of altering the current schedule, where all patients arrive at 8:00 AM, to a schedule that assigns patients to two or three different appointment times based on the expected length of their chemotherapy infusion. The results identify multiple scheduling policies that could be easily implemented with the best solutions reducing both average patient waiting time and average nurse overtime requirements. ARTICLE HISTORY

Improving Chemotherapy Infusion Operations through the Simulation of Scheduling Heuristics: a case study

“…Our best fit resulted in an arrival time distribution modeled by 6:30 AM + 168 × Beta(3.64, 3.35) minutes. Goodness of fit tests and sensitivity analysis for this choice (and others in this paper) may be found in Slocum (2014).…”

“…The simulation assumes a constant service time of 10 minutes throughout the day, which is double the average service time during these periods. Sensitivity analysis shows the results are insensitive to this assumption (Slocum, 2014). By using a service time of double the average service time, the model attempts to account for the impact non-chemotherapy patients would have on the phlebotomy queue length and waiting time.…”

“…Personal observations of the clinic confirm the simulation's backlog of chemotherapy orders at the data entry process is very indicative of true behavior. Interested readers should see Slocum (2014) for more validation details.…”

“…In 1930, the United States (U.S.) Congress authorized the President to establish the Veteran's Administration (VA) in order to provide care for the men and women who served in the U.S. military (Slocum, 2014;U.S. Department of Veterans Affairs, 2018b, 2018c.…”

Online scheduling using a fixed template: the case of outpatient chemotherapy drug administration

“…In the second stage, they assign patients to the minimum number of nurses required. Slocum et al [32] present a case study where discrete-event simulation shows a reduction in average waiting time and average overtime due to dividing the patients into two or three categories based on the appointment durations. Alvarado and Ntaimo [1] use stochastic programming for scheduling all the appointments of a patient's treatment, and [3] use stochastic programming to fine-tune the appointment times of an online schedule, a day or two before the schedule is implemented.…”