Improving workflow control in radiotherapy using discrete-event simulation
Abstract Background In radiotherapy, minimizing the time between referral and start of treatment (waiting time) is important to possibly mitigate tumor growth and avoid psychological distress in cancer patients. Radiotherapy pre-treatment workflow is driven by the scheduling of the first irradiation...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2019-10-01
|
| Series: | BMC Medical Informatics and Decision Making |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12911-019-0910-0 |
| _version_ | 1818217760424984576 |
|---|---|
| author | Bruno Vieira Derya Demirtas Jeroen B. van de Kamer Erwin W. Hans Wim van Harten |
| author_facet | Bruno Vieira Derya Demirtas Jeroen B. van de Kamer Erwin W. Hans Wim van Harten |
| author_sort | Bruno Vieira |
| collection | DOAJ |
| description | Abstract Background In radiotherapy, minimizing the time between referral and start of treatment (waiting time) is important to possibly mitigate tumor growth and avoid psychological distress in cancer patients. Radiotherapy pre-treatment workflow is driven by the scheduling of the first irradiation session, which is usually set right after consultation (pull strategy) or can alternatively be set after the pre-treatment workflow has been completed (push strategy). The objective of this study is to assess the impact of using pull and push strategies and explore alternative interventions for improving timeliness in radiotherapy. Methods Discrete-event simulation is used to model the patient flow of a large radiotherapy department of a Dutch hospital. A staff survey, interviews with managers, and historical data from 2017 are used to generate model inputs, in which fluctuations in patient inflow and resource availability are considered. Results A hybrid (40% pull / 60% push) strategy representing the current practice (baseline case) leads to 12% lower average waiting times and 48% fewer first appointment rebooks when compared to a full pull strategy, which in turn leads to 41% fewer patients breaching the waiting time targets. An additional scenario analysis performed on the baseline case showed that spreading consultation slots evenly throughout the week can provide a 21% reduction in waiting times. Conclusions A 100% pull strategy allows for more patients starting treatment within the waiting time targets than a hybrid strategy, in spite of slightly longer waiting times and more first appointment rebooks. Our algorithm can be used by radiotherapy policy makers to identify the optimal balance between push and pull strategies to ensure timely treatments while providing patient-centered care adapted to their specific conditions. |
| first_indexed | 2024-12-12T07:12:59Z |
| format | Article |
| id | doaj.art-d25a29e86c8f4705811eb2c899c872c5 |
| institution | Directory Open Access Journal |
| issn | 1472-6947 |
| language | English |
| last_indexed | 2024-12-12T07:12:59Z |
| publishDate | 2019-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Informatics and Decision Making |
| spelling | doaj.art-d25a29e86c8f4705811eb2c899c872c52022-12-22T00:33:35ZengBMCBMC Medical Informatics and Decision Making1472-69472019-10-0119111310.1186/s12911-019-0910-0Improving workflow control in radiotherapy using discrete-event simulationBruno Vieira0Derya Demirtas1Jeroen B. van de Kamer2Erwin W. Hans3Wim van Harten4Department of Radiation Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek HospitalCenter for Healthcare Operations Improvement and Research (CHOIR), University of TwenteDepartment of Radiation Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek HospitalCenter for Healthcare Operations Improvement and Research (CHOIR), University of TwenteDepartment of Radiation Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek HospitalAbstract Background In radiotherapy, minimizing the time between referral and start of treatment (waiting time) is important to possibly mitigate tumor growth and avoid psychological distress in cancer patients. Radiotherapy pre-treatment workflow is driven by the scheduling of the first irradiation session, which is usually set right after consultation (pull strategy) or can alternatively be set after the pre-treatment workflow has been completed (push strategy). The objective of this study is to assess the impact of using pull and push strategies and explore alternative interventions for improving timeliness in radiotherapy. Methods Discrete-event simulation is used to model the patient flow of a large radiotherapy department of a Dutch hospital. A staff survey, interviews with managers, and historical data from 2017 are used to generate model inputs, in which fluctuations in patient inflow and resource availability are considered. Results A hybrid (40% pull / 60% push) strategy representing the current practice (baseline case) leads to 12% lower average waiting times and 48% fewer first appointment rebooks when compared to a full pull strategy, which in turn leads to 41% fewer patients breaching the waiting time targets. An additional scenario analysis performed on the baseline case showed that spreading consultation slots evenly throughout the week can provide a 21% reduction in waiting times. Conclusions A 100% pull strategy allows for more patients starting treatment within the waiting time targets than a hybrid strategy, in spite of slightly longer waiting times and more first appointment rebooks. Our algorithm can be used by radiotherapy policy makers to identify the optimal balance between push and pull strategies to ensure timely treatments while providing patient-centered care adapted to their specific conditions.http://link.springer.com/article/10.1186/s12911-019-0910-0Workflow controlRadiotherapyDiscrete-event simulationResource planningWaiting times |
| spellingShingle | Bruno Vieira Derya Demirtas Jeroen B. van de Kamer Erwin W. Hans Wim van Harten Improving workflow control in radiotherapy using discrete-event simulation BMC Medical Informatics and Decision Making Workflow control Radiotherapy Discrete-event simulation Resource planning Waiting times |
| title | Improving workflow control in radiotherapy using discrete-event simulation |
| title_full | Improving workflow control in radiotherapy using discrete-event simulation |
| title_fullStr | Improving workflow control in radiotherapy using discrete-event simulation |
| title_full_unstemmed | Improving workflow control in radiotherapy using discrete-event simulation |
| title_short | Improving workflow control in radiotherapy using discrete-event simulation |
| title_sort | improving workflow control in radiotherapy using discrete event simulation |
| topic | Workflow control Radiotherapy Discrete-event simulation Resource planning Waiting times |
| url | http://link.springer.com/article/10.1186/s12911-019-0910-0 |
| work_keys_str_mv | AT brunovieira improvingworkflowcontrolinradiotherapyusingdiscreteeventsimulation AT deryademirtas improvingworkflowcontrolinradiotherapyusingdiscreteeventsimulation AT jeroenbvandekamer improvingworkflowcontrolinradiotherapyusingdiscreteeventsimulation AT erwinwhans improvingworkflowcontrolinradiotherapyusingdiscreteeventsimulation AT wimvanharten improvingworkflowcontrolinradiotherapyusingdiscreteeventsimulation |