Martini Hospital and RUG collaborate on innovative application for outpatient '1.5 meter care' plans

When starting regular care, ensuring patient safety is the most important starting point. The Martini Hospital wants to help as many patients as possible, but it must not become too busy in the hospital or in the waiting rooms. The Martini and the University of Groningen (RUG) are therefore working together to develop an innovative application for scheduling outpatient "1.5 meter care. Dr. Justin Drupsteen, Manager Integral Capacity Management at Martini Hospital: "Due to the 1.5 meter measures, the number of patients present in a waiting room at the same time will sometimes have to be reduced by as much as 75%. In order to provide the best possible service to patients, we have to introduce a completely new way of scheduling our outpatient clinics and diagnostics such as X-ray and ultrasound." 

Patient safety through planning

From the end of April, the Martini Hospital again increased the proportion of regular care. Patient safety is the main focus; think of measures such as one-way traffic, screening at the entrance and distance indications in the corridors. Also in the waiting rooms 1.5 meters distance is taken into account. This means that fewer patients can be present in a waiting room at the same time and thus fewer treatment rooms can be scheduled at the same time. Whereas before the COVID-19 outbreak the constraint for care was the number of doctors, nurses or treatment rooms, now it is the waiting room.

Justin Drupsteen: "Of course we know that there are many people waiting for their treatment or examination. In this situation, you want to make sure that the available space is used optimally. Together with the RUG, we are working on a tool that generates outpatient schedules that take into account many of the challenges of the 1.5m society. For the tool to work as well as possible, it is important that patients do not arrive too late but also not too early; the more the appointment time is deviated from, the fuller the waiting rooms become."

Planning uncertainty or the uncertainty of planning

The application was developed by RUG researchers Prof. Dr. Iris Vis, Prof. Dr. Kees Jan Roodbergen, Dr. Michiel uit het Broek and Dr. Ilke Bakir. Michiel uit het Broek, researcher in the Operations Department of the Faculty of Economics and Business, explains: "We developed a mathematical model that generates appointment schedules in which as many patients as possible can be seen, but the number of simultaneously waiting patients is kept as low as possible, by applying all kinds of spreading options. For example, not all appointments start at the same time, doctors' breaks shift, free treatment rooms are used as waiting areas, and space is maintained between appointments. This is obviously less efficient for the doctors, but it is sometimes necessary to ensure that there are not too many patients in the waiting room at the same time."

Iris Vis, Professor of Engineering: "The application also provides estimates for the risks of potentially exceeding the maximum capacity of the waiting room. After all, there is always a chance that in practice things will go differently than expected, for example because an appointment runs out. But of course the tool can never predict exactly how individual doctors, staff and patients behave. Nor whether all organizational measures are effectively implemented. That's why it's important to build up slowly."

The idea is to start with a low number of appointments, for example at 40% of the normal number of appointments. If this proves to work well in practice, the number of appointments can then be increased in increments using the appointment schedules provided by the tool.

Testing

The first version is now being tested at the Obstetrics and Gynecology outpatient clinic. Many specialties have different appointment types, something that makes scheduling even more complicated. Dr. Marinus van der Ploeg, gynecologist at the Martini: "We want to provide everyone with the care they need as quickly as possible. Spreading out in space and time is the motto. This is a huge logistical challenge and we are very happy that the RUG is helping us with this." The tool was not developed specifically for Obstetrics and Gynecology; all specialties can use this tool as planning support. Therefore, the Martini Hospital wants to start using the application at all other polyclinics as soon as possible. Patients will of course be extensively informed about the modified logistics at the hospital.

Next steps

In the follow-up study, the application will be expanded by also taking into account practical aspects such as physician availability and wishes about what constitutes a good appointment schedule. In addition, by applying the tool, insights can be gained into the effects of the measures on the available care capacity in the hospital. Furthermore, the possibilities for automatic linking with hospital information systems are being explored. Currently, the researchers are working with the computational cluster of the Center for Information Technology of the RUG to develop a web interface, and to calculate complex schedules.

Other hospitals interested in this project can find more information at www.rug.nl/cope/1.5