Nursing care flexibility in chemotherapy appointment scheduling

The flexibility level allowed in nursing care delivery and the uncertainty in infusion durations are important factors for chemotherapy scheduling. The nursing care delivery scheme employed in an outpatient chemotherapy clinic (OCC) determines the strictness of the patient-to-nurse assignment policies, while the estimation of infusion durations affects the trade-off between patient waiting time and nurse overtime. We study the problem of daily scheduling of patients, assignment of patients to nurses and chairs in the presence of uncertainty in infusion durations for an OCC that functions according to any of the commonly used nursing care delivery system representing fully, partially, and inflexible care systems. We develop a two-stage stochastic mixed-integer programming model minimizing expected weighted cost of patient waiting time and nurse overtime. We propose multiple variants of a scenario grouping-based decomposition algorithm to solve the model using data from a major university oncology hospital. We compare input-based, solution-based, and random scenario grouping methods within the decomposition algorithm. We obtain near-optimal schedules that are also significantly better than the schedules generated based on the policy used in the clinic. We analyze the impact of nursing care flexibility in order to determine whether a partial or fully flexible delivery system is necessary to adequately improve waiting time and overtime.