Operations research methods improve chemotherapy patient appointment scheduling.

BACKGROUND: Clinical complexity, scheduling restrictions, and outdated manual booking processes resulted in frequent clerical rework, long waitlists for treatment, and late appointment notification for patients at a chemotherapy clinic in a large cancer center in British Columbia, Canada. A 17-month study was conducted to address booking, scheduling and workload issues and to develop, implement, and evaluate solutions. METHODS: A review of scheduling practices included process observation and mapping, analysis of historical appointment data, creation of a new performance metric (final appointment notification lead time), and a baseline patient satisfaction survey. Process improvement involved discrete event simulation to evaluate alternative booking practice scenarios, development of an optimization-based scheduling tool to improve scheduling efficiency, and change management for implementation of process changes. Results were evaluated through analysis of appointment data, a follow-up patient survey, and staff surveys. RESULTS: Process review revealed a two-stage scheduling process. Long waitlists and late notification resulted from an inflexible first-stage process. The second-stage process was time consuming and tedious. After a revised, more flexible first-stage process and an automated second-stage process were implemented, the median percentage of appointments exceeding the final appointment notification lead time target of one week was reduced by 57% and median waitlist size decreased by 83%. Patient surveys confirmed increased satisfaction while staff feedback reported reduced stress levels. CONCLUSION: Significant operational improvements can be achieved through process redesign combined with operations research methods.

Process data: a means to measure operational performance and implement advanced analytical models.

We present the case of an ambulatory clinic in which an operational review was conducted to identify opportunities for efficiency in appointment scheduling and capacity allocation. We required process data to compare that which was planned to that which actually happened and to develop advanced analytical models. Similar to other health care studies, these data proved to be limited or non-existent. Consequently we had to conduct a time-consuming collection of operational metrics. We make recommendations for the perpetual collection of process data for modeling and simulation.

Benefits and challenges of health information systems for operations research: an illustrative example to improve surgical scheduling.

Operations research (OR) is playing an increasing role in the support of many health care initiatives. However one of the main challenges facing OR practitioners is the availability and the integrity of operations data. Hospital information systems (HIS) are often designed with a clinical or accounting focus and may lack the data necessary for operational studies. In this paper, we illustrate the data processing methods and data challenges faced by our team during a study of surgical scheduling practices at the Vancouver Island Health Authority. We also provide some general recommendations to improve HIS from an operations perspective. In general, more integration between operations researchers and HIS specialists are required to support ongoing operational improvements in the health care sector.

Reducing patient wait times and improving resource utilization at British Columbia Cancer Agency's ambulatory care unit through simulation.

We consider an ambulatory care unit (ACU) in a large cancer centre, where operational and resource utilization challenges led to overcrowding, excessive delays, and concerns regarding safety of critical patient care duties. We use simulation to analyze the simultaneous impact of operations, scheduling, and resource allocation on patient wait time, clinic overtime, and resource utilization. The impact of these factors has been studied before, but usually in isolation. Further, our model considers multiple clinics operating concurrently, and includes the extra burden of training residents and medical students during patient consults. Through scenario analyses we found that the best outcomes were obtained when not one but multiple changes were implemented simultaneously. We developed configurations that achieve a reduction of up to 70% in patient wait times and 25% in physical space requirements, with the same appointment volume. The key findings of the study are the importance of on time clinic start, the need for improved patient scheduling; and the potential improvements from allocating examination rooms flexibly and dynamically among individual clinics within each of the oncology programs. These findings are currently being evaluated for implementation by senior management.

Optical analysis of perfusion bioreactor cell concentration in an acoustic separator.

Automated monitoring of cell concentration in perfusion bioprocesses facilitates the maintenance of constant cell specific perfusion rates. However, most on-line measuring devices are relatively complex and foul as the culture progresses. A simple external optical sensor was developed using the transparent glass walls of acoustic separators for automated optical analysis of their contents. For each measurement, the separator was filled by an automated pumping system with triplicate representative bioreactor samples that were optically analyzed and the device returned to perfusion operation within approximately 1 or 2 min. Chinese hamster ovary cell concentrations, ranging from 5 x 10(5) to 2 x 10(7) cells/mL, were highly correlated (R(2) = 0.99) with the 90 degrees scattered light response. Since the device was operated externally, it did not complicate bioreactor sterilization or cleaning. Viability was not optically analyzed, but this information was not required between manual samples of a properly operated perfusion process. Using single-point recalibration based on routine off-line samples, this external optical system remained effective during a 4-month perfusion run, thus providing a non-invasive and easily maintained on-line cell concentration monitoring system to improve the control of perfusion bioreactors.