Scheduling the hospital-wide flow of elective patients

In this paper, we address the problem of planning the patient flow in hospitals subject to scarce medical resources with the objective of maximizing the contribution margin. We assume that we can classify a large enough percentage of elective patients according to their diagnosis-related group (DRG) and clinical pathway. The clinical pathway defines the procedures (such as different types of diagnostic activities and surgery) as well as the sequence in which they have to be applied to the patient. The decision is then on which day each procedure of each patient's clinical pathway should be done, taking into account the sequence of procedures as well as scarce clinical resources, such that the contribution margin of all patients is maximized. We develop two mixed-integer programs (MIP) for this problem which are embedded in a static and a rolling horizon planning approach. Computational results on real-world data show that employing the MIPs leads to a significant improvement of the contribution margin compared to the contribution margin obtained by employing the planning approach currently practiced. Furthermore, we show that the time between admission and surgery is significantly reduced by applying our models.