Research at HCL

The emergency medical service comprises emergency rescue and patient transport. In emergency rescue, most operations are covered by ground-based emergency rescue with rescue ambulances and emergency medical vehicles. The ground-based emergency rescue is supported by air rescue with rescue helicopters. Patient transport is mostly carried out by transport ambulances. Ambulances and their rescue equipment can be cross-used by the emergency rescue and patient transport.

Logistical planning problems in emergency medical services arise at strategic, tactical, and operational levels. Decisions at a strategic level are the location of ambulance stations, the calculation of the number of required rescue workers and rescue resources and the planning of ambulance service areas, with a planning horizon of several years. At the tactical level, issues such as the allocation of rescue resources to the stations and the shift planning of the emergency personnel are considered. Short-term operational decisions include the dispatching of rescue resources to emergencies as they arise. The dynamic repositioning of rescue resources during the day is also considered at the operational level. In the area of patient transport route planning problems play a role. At all levels, methods for emergency prediction can support decision-making, for example, through time series analyses or with machine learning methods.

The versatility of the performance dimensions in the emergency medical service must be considered in all planning problems. Next to medical requirements for a rapid arrival in critical situations, a fair provision for the entire population in urban as well as rural areas and an efficient use of resources must be included in the planning process

In most western countries, a shortage of family doctors can be observed, especially in rural areas. Also in view of an aging society, new and better planning methods in this environment are urgently needed.

Area Planning

Every German citizen should have equal access to medical care. In order to determine the respective need, the country must be meaningfully divided into areas and their respective needs must be determined. The consideration of the problem will certainly become more relevant in the coming years, as the number of GPs will continue to decrease, especially in rural areas.

Personnel planning/shift planning

The problem of personnel and duty planning is relevant for all employees in health care facilities, such as doctors, nurses and medical assistants. It is important to take into account legal and operational requirements as well as personal wishes to achieve a service level.

Scheduling

This problem is essential in all areas of healthcare where patients are involved and have to be scheduled. If an exclusive walk-in policy is not pursued, rules for scheduling and patient selection must first be established. In the next step, simulations can then be carried out to check developed scenarios.

Reforms in the health care system have put hospitals under constantly increasing cost and competitive pressure in recent years. For example, with the introduction of diagnosis-based flat rates per case (DRG), the principle of self-funding has been abolished in favour of remuneration based on medical performance in order to create incentives for the economic behaviour that was often lacking in the past. This should lead to a sustainable improvement in the quality, transparency and economic efficiency of inpatient hospital services. In order to achieve these goals, it is necessary to analyze existing processes and, if necessary, make them more efficient, so that, for example, the length of stay can be reduced. For this purpose, Operations Research offers numerous methods that can lead to significant improvements not only in an industrial environment but also in a hospital. However, a special feature in this area of application is that the focus must not only be on economic efficiency, but that it is also essential to take into account treatment quality and patient satisfaction. An intervention in medical competence does not occur in this context.

In health care management, questions of process planning and internal logistics in hospitals play a major role. Patients are examined, treated and, if possible, cured with the help of medical-technical equipment. The technical and organizational measures in a hospital operation, by which patients, goods and related information are transferred from an initial state ("sick") to a final state (in the best case "healthy"), are summarized under the term hospital logistics. The processes in a hospital have often grown historically, so that a critical process analysis is missing ("This has always been done this way.") However, since reforms are increasingly demanding that hospitals behave economically, processes are now often questioned and opportunities for improvement sought. The success of logistics concepts in hospitals therefore lies in the conservation of resources. Successful hospital logistics enables good medical care with minimal resource consumption for activities that do not add value, i.e. are not directly relevant to the healing process. Modern planning procedures allow the interests of the various stakeholders of the hospital to be taken into account.

Examples of the use of operations research methods along the clinical treatment pathway are briefly described below.

Stock-keeping

In a hospital, in addition to the central warehouse for non-medical consumables and the pharmacy for drugs and other medical supplies, there are usually additional supply cabinets on the wards (demand point warehouse). The material and drug stocks must therefore be monitored at every level, unless a concept for stock consolidation is developed. Depending on the size of the central warehouse and the pharmacy, picking must also be planned. The storage of blood reserves also poses a major challenge. In addition to correct storage, ensuring sufficient stocks and observing expiration dates play a decisive role here.

Layout planning

In practice, the layout planning for hospitals is usually carried out by specialized architectural firms. They design a layout in particular in compliance with relevant guidelines and taking into account the requirements set out in the tender. Operational costs that are later influenced by the layout, such as long distances for staff and patients, are not taken into account in the planning phase. Also the multi-periodic view, which includes changes in the need for single, double and multi-bed rooms, for example, is often missing. To close these gaps, quantitative methods of operations research are used, so that improved layout plans for hospitals can be developed using existing data, e.g. from clinical treatment pathways.

Surgery planning

In a hospital, the operating rooms are both the main cost drivers and the largest source of income. For this reason, efficient use of the bottleneck operating room must be ensured. In OR planning, a distinction is made between long-term, short-term and medium-term planning. In the long term, the number of operating rooms is determined together with the assignment of contingents to departments. In the medium term, the weekly plan for each department is based on this. The planning of the OR schedule for the next day(s) and the necessary adjustment for the treatment of emergencies or if other delays occur, is carried out at short notice.

Transport Planning

During their stay in hospital, patients visit and go through various diagnostic, therapeutic or treatment facilities. For this patient transport, which must be carried out within a building or between different buildings, hospitals often have their own transport teams. Transport orders are assigned to these employees and the corresponding tours are planned. The dynamics of the transport orders to be executed and the consideration of quarantine, priorities, emergencies, vehicle capacities, etc. pose a particular challenge.