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.