Assessing the impact of patient prioritization on operating room schedules

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES Operations Research for Health Care Pub Date : 2020-03-01 DOI:10.1016/j.orhc.2019.100232
Mariana Oliveira , Valérie Bélanger , Inês Marques , Angel Ruiz
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引用次数: 17

Abstract

This paper proposes an integrated approach to merge patient prioritization and patient scheduling to improve access to services in an elective (i.e., non-urgent) context. In particular, we assume that patients are included on a waiting list for a given surgery, and that every patient on the list has received a “utility score”, which is a proxy for the relative urgency with regards to the other patients on the list. A mathematical model is formulated to solve the patient scheduling problem, i.e., the simultaneous assignment of surgery sessions to surgeons and patients to surgeons, in such a way that the total utility is maximized along with other practical requirements. The model has been applied to a testbed of randomly generated instances, inspired by the context of the Urology Department at a University Hospital in Quebec City. Experiments have been conducted to analyze both the short- and medium-term behaviors of the proposed approach. The numerical results confirm that the use of an objective function designed to maximize utility does not deteriorate the efficiency of the resulting schedules in terms of the number of surgeries performed. They also show that, as expected, higher utility patients are scheduled first, and their waiting time before surgery are shorter than those of lower utility. However, this approach may lead to longer, and even unacceptable waiting times for low utility patients. To mitigate such an undesirable effect, a dynamic utility updating approach is proposed to progressively increase the utility of patients according to their time spent on the waiting list. This approach seems to adequately balance the advantages of scheduling patients based on their utility and the risk of causing too much delay for low priority patients.

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评估病人优先次序对手术室安排的影响
本文提出了一种整合的方法来合并患者优先级和患者调度,以改善在可选(即非紧急)环境中获得服务的机会。具体地说,我们假设患者被列在等待某一手术的名单上,并且名单上的每个患者都得到了一个“效用评分”,这是与名单上其他患者相比的相对紧迫性的代理。建立了患者调度问题的数学模型,即同时将手术时段分配给外科医生,同时将患者分配给外科医生,以使总效用最大化并满足其他实际需求。受魁北克市一家大学医院泌尿科的启发,该模型已应用于随机生成实例的测试平台。实验分析了该方法的短期和中期行为。数值结果证实,使用旨在使效用最大化的目标函数不会降低所产生的手术数量方面的效率。他们还表明,正如预期的那样,高效用患者首先被安排,他们的手术前等待时间比低效用患者短。然而,这种方法可能会导致低效用患者等待时间更长,甚至无法接受。为了减轻这种不良影响,提出了一种动态效用更新方法,根据患者在等待名单上花费的时间逐步增加患者的效用。这种方法似乎充分平衡了基于效用安排患者的优势和对低优先级患者造成过多延迟的风险。
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来源期刊
Operations Research for Health Care
Operations Research for Health Care HEALTH CARE SCIENCES & SERVICES-
CiteScore
3.90
自引率
0.00%
发文量
9
审稿时长
69 days
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