8 research outputs found

    Integrated patient-to-room and nurse-to-patient assignment in hospital wards

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    Assigning patients to rooms and nurses to patients are critical tasks within hospitals that directly affect patient and staff satisfaction, quality of care, and hospital efficiency. Both patient-to-room assignments and nurse-to-patient assignments are typically agreed upon at the ward level, and they interact in several ways such as jointly determining the walking distances nurses must cover between different patient rooms. This motivates to consider both problems jointly in an integrated fashion. This paper presents the first optimization models and algorithms for the integrated patient-to-room and nurse-to-patient assignment problem. We provide a mixed integer programming formulation of the integrated problem that considers the typical objectives from the single problems as well as additional objectives that can only be properly evaluated when integrating both problems. Moreover, motivated by the inherent complexity that results from integrating these two NP-hard and already computationally challenging problems, we devise an efficient heuristic for the integrated patient-to-room and nurse-to-patient assignment problem. To evaluate the running time and quality of the solution obtained with the heuristic, we conduct extensive computational experiments on both artificial and real-world instances. The artificial instances are generated by a parameterized instance generator for the integrated problem that is made freely available

    Automated medical scheduling : fairness and quality

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    Dans cette thèse, nous étudions les façons de tenir compte de la qualité et de l’équité dans les algorithmes de confection automatique d’horaires de travail. Nous découpons ce problème en deux parties. La modélisation d’un problème d’horaires permet de créer des horaires plus rapidement qu’un humain peut le faire manuellement, puisqu’un ordinateur peut évaluer plusieurs horaires simultanément et donc prendre des décisions en moins de temps. La première partie du problème étudié consiste à améliorer la qualité des horaires en encodant des contraintes et des préférences à l’aide de modèles mathématiques. De plus, puisque la création est plus rapide à l’aide d’un ordinateur, il est plus facile pour un ordinateur de trouver l’horaire ayant la meilleure qualité lorsque les règles et préférences sont clairement définies. Toutefois, déterminer les règles et préférences d’un groupe de personne n’est pas une tâche facile. Ces individus ont souvent de la difficulté à exprimer formellement leurs besoins et leurs préférences. Par conséquent, la création d’un bon modèle mathématique peut prendre beaucoup de temps, et cela même pour un expert en création d’horaires de travail. C’est pourquoi la deuxième partie de cette thèse concerne la réduction du temps de modélisation à l’aide d’algorithmes capable d’apprendre un modèle mathématique à partir de solutions données comme par exemple, dans notre cas, des horaires de travail.In this thesis, we study the ways to take quality and fairness into account in the algorithms of automatic creation of work schedules. We separate this problem into two subproblems. The modeling of a scheduling problem allows a faster creation of schedules than what a human can produce manually. A computer can generate and evaluate multiple schedules at a time and therefore make decisions in less time. This first part of the studied problem consists in improving the quality of medical schedules by encoding constraints and preferences using mathematical models. Moreover, since the creation is faster, it is easier for a computer to find the schedule with the highest quality when the rules and the preferences are clearly defined. However, determining the rules and preferences of a group of people is not an easy task. Those individuals often have difficulties formally expressing their requirements and preferences. Therefore, the creation a good mathematical model might take a long time, even for a scheduling expert. This is why the second part of this thesis concerns the reduction of modeling time using algorithms able to learn mathematical models from given solutions, in our case schedules

    Charge Nurse Expertise: Implications for Decision Support of the Nurse-Patient Assignment Process

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    University of Minnesota Ph.D. dissertation. 2019. Major: Health Informatics. Advisor: David Pieczkiewicz. 1 computer file (PDF); 201 pages.Each day, across thousands of medical-surgical inpatient nursing units, charge nurses make decisions about which nurse will care for each patient. Recent attempts have been made to introduce health information technology (HIT) solutions to automate the nurse-patient assignment process. This research investigated charge nurse decision making during the nurse-patient assignment process as an exemplar of the larger question: How can we leverage information technology to improve decision making in healthcare, while respecting individual clinician expertise and the unique context of individualized patient care? Four primary questions were used to guide research of the process, decision factors, goals and context of nurse-patient assignments. A mixed-methods approach of qualitative interviews (N = 11) and quantitative surveys (N = 135) was used. Findings related to the charge nurse decision making process indicate that measurable, nurse-sensitive indicators of patient outcomes have not yet been standardized for nurse-patient assignments. HIT solutions and quality improvement efforts should define, collect and analyze measurable outcome criteria prior to attempting to improve or augment existing nurse-patient assignment practices to prevent unintended consequences. When clear outcome measurements have been identified, informatics researchers and professionals should investigate the ability of machine learning to recognize goal priorities and factor weighting from patient, nurse and environmental factors within existing HIT solutions. Until that time, HIT solutions augmenting the nurse-patient assignment process should be designed with flexible configurations, to enable goals, decision factors and factor weights can be varied by hospital, unit, charge nurse and shift, in order to best meet the needs of charge nurses

    An Integrated Framework for Staffing and Shift Scheduling in Hospitals

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    Over the years, one of the main concerns confronting hospital management is optimising the staffing and scheduling decisions. Consequences of inappropriate staffing can adversely impact on hospital performance, patient experience and staff satisfaction alike. A comprehensive review of literature (more than 1300 journal articles) is presented in a new taxonomy of three dimensions; problem contextualisation, solution approach, evaluation perspective and uncertainty. Utilising Operations Research methods, solutions can provide a positive contribution in underpinning staffing and scheduling decisions. However, there are still opportunities to integrate decision levels; incorporate practitioners view in solution architectures; consider staff behaviour impact, and offer comprehensive applied frameworks. Practitioners’ perspectives have been collated using an extensive exploratory study in Irish hospitals. A preliminary questionnaire has indicated the need of effective staffing and scheduling decisions before semi-structured interviews have taken place with twenty-five managers (fourteen Directors and eleven head nurses) across eleven major acute Irish hospitals (about 50% of healthcare service deliverers). Thematic analysis has produced five key themes; demand for care, staffing and scheduling issues, organisational aspects, management concern, and technology-enabled. In addition to other factors that can contribute to the problem such as coordination, environment complexity, understaffing, variability and lack of decision support. A multi-method approach including data analytics, modelling and simulation, machine learning, and optimisation has been employed in order to deliver adequate staffing and shift scheduling framework. A comprehensive portfolio of critical factors regarding patients, staff and hospitals are included in the decision. The framework was piloted in the Emergency Department of one of the leading and busiest university hospitals in Dublin (Tallaght Hospital). Solutions resulted from the framework (i.e. new shifts, staff workload balance, increased demands) have showed significant improvement in all key performance measures (e.g. patient waiting time, staff utilisation). Management team of the hospital endorsed the solution framework and are currently discussing enablers to implement the recommendation
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