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首页> 外文期刊>BMC Medical Informatics and Decision Making >Improving workflow control in radiotherapy using discrete-event simulation
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Improving workflow control in radiotherapy using discrete-event simulation

机译：使用离散事件模拟改善放射治疗中的工作流程控制

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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. 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. 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. 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.
机译：在放疗中，最小化转诊至开始治疗之间的时间（等待时间）对于减轻肿瘤的生长并避免癌症患者的心理困扰非常重要。放射治疗的预处理工作流程是由第一个照射时间安排来驱动的，通常是在咨询后立即设置（拉策略），也可以在完成预处理工作流程后设置（推策略）。这项研究的目的是评估使用推挽策略的影响，并探索提高放射治疗及时性的替代干预措施。离散事件模拟用于对荷兰一家医院的大型放射治疗部门的患者流量进行建模。员工调查，与经理的访谈以及2017年以来的历史数据用于生成模型输入，其中考虑了患者流入量和资源可用性的波动。与完全拉动策略相比，代表当前实践（基准案例）的混合（拉动40％/推动60％）策略可减少12％的平均等待时间，并减少48％的首次预约重新预订，进而导致41％违反等待时间目标的患者减少了。对基准案例进行的其他情景分析表明，将咨询时段平均分配到整个星期可以将等待时间减少21％。尽管等待时间略长，并且首次预约改签的次数更多，但100％牵引策略比混合策略允许更多的患者在等待时间目标内开始治疗。放疗政策制定者可以使用我们的算法来确定推拉策略之间的最佳平衡，以确保及时治疗，同时提供适合其特定情况的以患者为中心的护理。

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