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Abstract
Inpatient dialysis units face an uncertain daily demand of hemodialysis procedures for end-stage renal disease (ESRD) patients hospitalized for health conditions that may or may not be directly related to their renal disease. While hospitalized, these patients must receive hemodialysis in addition to any medical service needed for their primary diagnosis. As a result, when demand for inpatient dialysis is high, required treatments and procedures may be delayed causing an increased length of stay (LOS). This paper presents an optimization model for scheduling hemodialysis inpatients that aims to maximize the efficiency of the dialysis unit while minimizing the tardiness of other scheduled procedures, as well as the number of inpatients affected by delays. The optimization model takes into account the dialysis protocols prescribed by a treating nephrologist, the variable duration of the dialysis treatments, the limited capacity of the dialysis equipment and personnel, as well as isolation requirements used to mitigate the spread of healthcare-associated infections (HAIs). The optimization model could be used on a daily basis by an inpatient dialysis unit to create robust and efficient schedules.
Keywords
Optimization, Scheduling, Hemodialysis, Inpatient, ESRD
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1. Introduction
End-stage renal disease (ESRD) is a chronic condition due to kidney failure that requires intensive and expensive dialysis treatments or transplantation. Since the 1980s, the prevalence and incidence of ESRD patients have steadily increased. In 2009, the prevalent ESRD population in the United States reached a total number of 571,000 patients, with an incidence of 116,000 new patients [1]. Hemodialysis patients accounted for 65% of the total prevalence of ESRD, while representing 92% of the new patients diagnosed with ESRD.
The United States Renal Data System (USRDS) [1] reports that ESRD expenditures reached $29 billion in 2009, representing about 6% of the total U.S. Medicare costs, of which, over 85% was spent on hemodialysis. The same report registered that hemodialysis patients are hospitalized an average of 1.90 times per year, with a mean yearly length of stay (LOS) per patient of 11.90 days. One reason for the relatively high hospitalization rate and LOS is that ESRD patients are prone to develop additional medical conditions [2], and thus they require treatment for both ESRD and their other conditions. Furthermore, ESRD patients admitted to...