Abstract
Over the last years home dialysis has become the preferred treatment option for some patients with kidney failure. However, determining efficient and effective daily home-dialysis service plans imposes multiple challenges to hospital administrators, as it is a complex task with a number of interrelated decisions. These decisions are about the number of nurses required for daily visits and their travel itineraries, and involve multiple (often conflicting) objectives.Working together with physicians and administrators from The Ottawa Hospital (TOH) in Canada, we have developed a system intended to support administrators of nephrology departments in creating daily visit schedules and routes for nurses assisting with dialysis treatment in patients' homes. The decision support system, called Home Dialysis Scheduler System (HDSS), employs a mixed-integer linear programming model to create daily nurse itineraries that minimize the cost of providing home dialysis for a pre-specified group of patients. In developing this model, we also considered nurses' workload balance, overtime work, need for mealtime breaks (lunch or dinner, depending on shift times), restrictions and preferences associated with the time of the visits, and different types of services provided to patients. The model was validated using data provided by the Division of Nephrology at TOH. The interface of the HDSS was developed following the principles of user-centred design and validated with a group of end-users. In the validation stage, daily visit schedules and nurse routes generated by the HDSS were compared to nurse itineraries created manually by hospital administrators. The use of the HDSS resulted in improved workload distribution among nurses, simpler routes, and reduced total distance travelled — which translates into lower costs for the home dialysis program. In this paper, we provide details about the mixed-integer linear programming model, describe the HDSS, and discuss its implementation results and managerial implications.
Published Version
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