Patient flow analysis in pain rehabilitation care

N. Baër, N. Kortbeek, N. Litvak, O. Roukens

Research output: Book/ReportReportProfessional

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Background: Rehabilitation Care is a treatment process that involves multiple disciplines, which are affiliated with different departments and use different planning horizons. This often results in planning difficulties and long waiting lists. In order to increase efficiency the Rehabilitation Centre "Het Roessingh" in the Netherlands has introduced the concept of treatment plans.

Purposes: We support Het Roessingh to make their organizational process ready for implementation of treatment plans with the managerial purpose to prospectively assess the consequences of various interventions, without experimenting on the real-world system.

Methods: We use mathematical models based on techniques from Operations Research and Management Science. A simulation model is used to analyze the integral impact of proposed organizational solutions on the patient flows.

Findings: First, given the number of referrals per week, a necessary number of intake slots is determined in order to satisfy the access time requirements. Second, we quantify capacity losses resulting from cancellations of interdisciplinary meetings,. Third, we conclude that several disciplines are going to form bottlenecks in patient flow once the treatment plans are implemented. Fourth, a balanced staffing rule is computed for each discipline, by which bottlenecks will be avoided and higher efficiency will be achieved,. Finally, we show that the system cannot function at demand/capacity ratios close to 100% because disciplines affect each other.

Practice Implications: A sufficient number of intake slots must be planned weekly. The interdisciplinary meetings are of great importance and must have top priority for practitioners. When the treatment plans are implemented, the proposed balanced staffing rule enables a higher efficiency than the current staffing rule. It must be accepted by the management that multidisciplinary care cannot function with 100% efficiency, because of the necessity to buffer for variation in demand, and the interdependency between the disciplines in each patient treatment.
Original languageEnglish
Place of PublicationEnschede
PublisherUniversity of Twente
Number of pages28
Publication statusPublished - Sept 2012

Publication series

PublisherDepartment of Applied Mathematics, University of Twente
ISSN (Print)1874-4850
ISSN (Electronic)1874-4850


  • Markov models
  • Operations research
  • Patient flow analysis
  • Health care management
  • Discrete event simulation


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