Real time patient scheduling orchestration for improving key performance indicators in a hospital emergency department.

Healthcare systems worldwide are increasingly subject to in-depth analysis. Problems in healthcare systems are of concern to the general public. For example, overcrowding in emergency departments creates several issues including longer waiting times, more frequent medical errors, a longer length of stay and worsened performance indicators. Overcrowding situations reduce the availability of staff and material resources, and therefore deteriorate the quality of care. The main cause of the overcrowding in emergency departments is the permanent interferences between the scheduled patients, unscheduled patients and urgent and unscheduled patients arriving at the emergency department. The objective of the present study is to develop an innovative decision support system that minimizes these interferences, while taking into account the perturbations that can occur throughout the day. The research's ultimate goal is to improve the performance indicators via two processes: the first is a memetic algorithm based on a four dimensional hypercube genetic algorithm and local search techniques, and the second is based on a multi-agent system which dynamically orchestrates the patient pathway (given by the scheduling algorithm). In order to test and validate our approach, experiments are designed with real data from the adult emergency department at Lille University Medical Center. Simulations showed that with our approach we were able to reduce the waiting time of patients by 28.12%. • Overcrowding situations reduce the availability of staff and material resources, and therefore deteriorate the quality of care. • The main cause of the overcrowding in emergency departments is the permanent interferences between the scheduled patients, unscheduled patients, and urgent and unscheduled patients. • The simulations showed that our hybrid approach can improve performance indicators and optimize. • A dynamic approach combining a memetic scheduling algorithm (MESA) and a multi-agent system to dynamically orchestrate the patient can improve performance indicators in real time while taking into account the medical staff availability and skills. [ABSTRACT FROM AUTHOR]