Admission Control And Appointment Scheduling For Pregnant Women In Obstetrics Units

With the opening of the two children policy in China,more attention was focused on services in obstetrics units.Pregnant women will go to one hospital and apply for admission after her ninth pregnant week.The regular prenatal visits,obstetric procedure and postnatal care will be in need if the woman is accepted.This procedure requires multiple medical resources and is full of uncertainties.So admission control and appointment scheduling for pregnant women in obstetrics units are rather important for the health of the women and the new-borns.What's more,they will affect the satisfaction of the staff in hospital and those pregnant women.Our study includes two stages.Firstly,making the admission control decision according to the limited resources;secondly making scheduling decision for those pregnant women been accepted according to their preferences.Pregnant women will go to one hospital and apply for admission after ninth pregnant week.The scheduler should make the instant decision of admission or not.It is challenging for scheduler to make such a decision due to the requirement of multiple resources,multi-reentrance,and uncertainties in the requirement time and service time of the critical resources.Improper decision will lead to the unbalancing of delivery time of pregnant women,resulting in the beds' idleness and overload,even the diversion of patients to other hospitals.To level up the utilization of the beds,this paper proposes a discrete-event simulation model and multiple threshold-based admission control policies.The parameters of the policies are improved with the objective of minimizing the weighted cost of beds' idle and overloaded and patients' diversion penalty.Pregnant women in obstetrical department have the feature of long-term and multi-reentrant examination.In order to improve the satisfaction degree of pregnant women by satisfying their preference for the examination time and reduce the overtime work of doctors,this paper puts forward a stochastic programming model with the objective of minimizing the penalty cost of preference violation and doctors' overtime cost for the examinations.The Monte Carlo method is adopted to handle the uncertainty of pregnant women's future arrival and preferences for the examination time.The original problem is reformulated as a linear programming model,which could be solved by the commercial solver Cplex.However,with the increasing of problem size,it is time consuming or even unsolvable by using Cplex.This paper proposes a linear programming model based on the number of arrived pregnant women in the current week and a greedy heuristic using Myopic Strategy to reduce the computational time.Numerical experiments show that the stochastic programming approach is better than the other two approaches with longer computing time.Sensitivity analysis show that larger arrival rate and larger dispersion of preference distribution leads to higher penalty cost.The penalty of pregnant women's unsatisfaction and doctors' overtime working are two different obejections.It is difficult to quantify those evaluation critirias.A multi-objective programming is used to slove this problem.?-constraint method is used to obtain the Pareto solution since it is the most common method to slove the multi-objective problem.This study based on the long-term cooperation with a top hospital in Shanghai.The goal is to provide theoretical guidance,which has significant academic value and real meanings for the better operation of the hospital management.