Methods and analytical tools for patient flow optimization

临床环境中的患者流问题涉及为每个患者确定活动的最佳顺序以及他们的预约。病人每次一个地进入系统，通常是因为他们被转诊到治疗中心或诊所，并等待预约。这种预约通常定义他们访问的开始时间（或治疗的开始日期）。每个病人都有一个事先不知道的档案。配置文件被定义为一组活动和每个活动的持续时间。一个或多个资源可以执行每个活动，并且某些活动具有优先约束。每天可能会有一个或多个活动。患者的到达时间、护理需求和服务时间通常是未知的。本建议考虑了两种不同的情况：多个预约，每个预约只涉及一项活动，但涉及不同的资源，以及单个预约，需要由不同的资源执行不同的活动。活动可能在同一天或更长时间内进行。例如，所有在直线加速器（用于放射治疗的机器）上进行放射治疗的预约都是在同一时间提前预约的。在其他门诊设置，如术前诊所，进行一次预约，所有活动，如血液检查，医生咨询和心电图必须安排在同一天。* * 有效的卫生系统必须有效地协调必要的资源和活动。虽然这是我的研究计划的长期目标，这项研究计划专门解决病人流问题，并与病人预约问题和资源规划和调度问题的整合。* * 将使用不同的工具和方法来解决这些问题。主要挑战与医疗保健方面的不确定性和问题的复杂性有关。我们将开发一个基于在线优化算法和高效元分析的方法框架。七个项目将分配给硕士和博士生。两个将开发在线算法的病人预约（分配给两个博士生，每个考虑不同的设置），和其他两个将探索大邻域元算法的资源规划（MSc #1）和调度（MSc #2）。项目五和项目六将集中于整合方法，以连接前四个项目的方法和解决方案;这些协调项目是我的研究计划的重点。最后，项目7将确保进行技术转让。预期的影响是减少因缺乏对有限资源的协调而造成的病人延误和瓶颈。

The patient flow problem in clinical settings involves determining for each patient the best sequence of activities as well as their appointment(s). Patients arrive in the system one at a time, typically because they are referred to the treatment centre or clinic, and wait for an appointment. This appointment usually defines the start time of their visit (or the start day of their treatment). Each patient has a profile that is not known in advance. The profile is defined to be a set of activities and a duration time for each activity. One or more resources may perform each activity, and some activities have precedence constraints. Each day one or more activities may occur. The arrival times, care needs, and service times of the patients are usually unknown.**Two different settings are considered in this proposal: multiple appointments each involving only one activity but different resources, and single appointments requiring different activities to be performed by different resources. Activities may occur in the same day or over a longer period of time. For example, all appointments for radiotherapy treatment on the linear accelerators (the machines used for radiotherapy) are booked in advance at the same time. Earlier appointments are set up with the physician, for the CT scan, etc. In other outpatient settings, such as preoperative clinics, a single appointment is made and all activities such as the blood test, the physician consultation, and the electrocardiogram must be scheduled on the same day. **An effective health system must efficiently coordinate the necessary resources and activities. While this is the long-term goal of my research program, this research proposal specifically addresses the patient flow problem and its integration with the patient booking problem and the resource planning and scheduling problems. **Different tools and methods will be used to tackle these problems. The main challenges are related to the uncertainty in the healthcare context and the complexity of the problems. We will develop a methodological framework based on online optimization algorithms and efficient metaheuristics. Seven projects will be assigned to MSc and PhD students. Two will develop online algorithms for patient booking (assigned to two PhD students, each considering a different setting), and two others will explore large-neighbourhood metaheuristics for resource planning (MSc #1) and scheduling (MSc #2). Projects five and six will focus on integration methods to link the methods and solutions of the first four projects; these coordination projects are the keystone of my research program. Finally project 7 will ensure that a technological transfer will occur.*The expected impact is to reduce patient delays and bottlenecks created by a lack of coordination of the limited resources.