Better healthcare through math — 4 operational learnings from UCSF

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Appointment scheduling represents a complex mathematical problem for infusion centers, which is often handled using linear logic. There is a better way.

During a November webinar hosted by Becker's Hospital Review and sponsored by LeanTaaS, a developer of hospital capacity management software, Mohan Giridharadas, founder and CEO of LeanTaaS, and Aubrey Wong, administrative director for adult infusion services at the University of California, San Francisco (UCSF), discussed challenges and opportunities for optimizing infusion scheduling.

Four learnings:

1. Optimizing infusion scheduling is a difficult math problem. The two fundamental concepts that determine overall capacity of an infusion center are supply (capacity) and demand. The supply side combines nurse availability, equipment (syringes, needles and medications) and facilities (infusion chairs or beds). On the demand side, variables are patient volume and the type, start time and duration of each procedure. Matching supply and demand, as well as how each treatment links with preceding phases of the infusion pathway — which typically include a lab test and a clinic visit — increases the number of variables and raises the scale of mathematical complexity.

2. EHRs are not built to solve capacity management. EHRs are designed to collect medical information; they simply treat scheduling as a reservation, with a firm start and end time. They cannot account for delays, yet if an infusion starts late, a patient cannot be kicked out at the originally scheduled time. EHRs are also built so that are that schedulers enter appointments on a first-come, first-served basis and don't allow for probability estimates or simulation building to match true supply and demand patterns.

3. A model that accurately predicts the volume, duration and mix of treatments can help unlock capacity. With the aid of algorithms that run billions of permutations and combinations of possible appointments — given the unique features of each appointment and each infusion center — LeanTaaS arrives at an optimal arrangement for an infusion center. This optimal arrangement ensures that even in peak hours there are available infusion chairs for each patient. "What we are doing is identifying and predicting the best appointment slot for each treatment for patients any day in the future. And then on the day of treatment, we provide real-time guidance," Mr. Giridharadas said.

4. Infusion centers that use LeanTaaS have seen a decrease in wait times and an increase in patient satisfaction. This is the case at a 15-chair UCSF infusion center, which experienced an average decrease in wait times of 26 percent across all weekdays and 45 percent on Mondays. This infusion center decreased average hours over capacity on weekdays between 21 percent and 100 percent and completely eliminated over capacity on Fridays. "That was a huge accomplishment for us and a huge satisfier for our employees as well as our patients," Ms. Wong said.

By using AI-driven software solutions that deploy predictive analytics and algorithms adapted to facility features and patient case mix, infusion centers can overcome capacity-related operational challenges and optimize appointment scheduling.

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