Integrating nurse assignment in outpatient chemotherapy appointment scheduling

Abstract

In outpatient chemotherapy, nurses administer the drugs in two steps. In the first few minutes of each appointment, a nurse prepares the patient for infusion (drug administration). During the remainder of the appointment, the patient is monitored by nurses and if needed taken care of. One nurse must be assigned to prepare the patient and set up the infusion device. However, a nurse who is not busy setting up may simultaneously monitor up to a certain number of patients who are already receiving infusion. The prescribed infusion durations are significantly different among the patients on a day at a clinic. We formulate this problem as a multi-criterion mixed integer program. The appointments should be scheduled with start times close to patients’ ready times, balanced workload among nurses, few nurse changes during appointments, and few nurse full-time equivalent (FTE) assigned to the schedule of the day. As the number of nurse FTEs is an output of the model rather than a fixed input, the clinic can use the nursing capacity more efficiently, i.e., with less labor cost. We develop a 3-stage heuristic for finding criterion points with the minimum weighted average deferring time of appointments for the minimum feasible number of nurse FTEs or a desired value above that. By not constraining the number of chairs or beds, we can find solutions with better (dominating) criterion points. Drug preparation, oncologist visit, and the laboratory test can be scheduled based on the drug administration appointment start time. Thus, the drug administration resources are efficiently used with desirable performance in taking the interests and requirements of various stakeholders into consideration: patients, nurses, oncologists, pharmacy, and the clinic.

Multi–stage process for chemotherapy scheduling and effective capacity determination

“…Hahn-Goldberg et al (2014) and Ramos et al (2020) include drug preparation times among the decisions made by the model. More recently, Hesaraki et al (2020) studied the integration of nurse assignment with intraday treatment scheduling. They developed a multi-criterion mixed integer program that seeks to maintain high nurse utilization and control workload levels, despite variations in the number and workload of requests.…”

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

“…If the test results are unsatisfactory, the treating oncologist or a nurse decides to postpone the Fig. 2 Flow of information in online and offline appointment scheduling (adopted from [13])…”

“…In this section, we present a mixed integer program (MIP) adopted from a special case of the integrated offline scheduling model of [13] for assigning the setup and monitoring tasks to the nurses. The objective is to have equal workload distributed among the nurses and as few nurse changes during appointments as possible.…”

Clustering and Stochastic Simulation Optimization for Outpatient Chemotherapy Appointment Planning and Scheduling

“…The scholars in this area have built upon optimization studies that preceded their work to develop more comprehensive optimization models. Most deterministic optimization models are integer [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ] or mixed integer programming [ 7 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ]. In mixed integer models, some of the decision variables (but not all) all required to have integer values.…”