This research is motivated by our collaborations with a large French university teaching hospital in order to reduce the Length of Stay (LoS) of stroke patients treated in the neurovascular department. Quick diagnosis is critical for stroke patients but relies on expensive and heavily used imaging facilities such as MRI (Magnetic Resonance Imaging) scanners. Therefore, it is very important for the neurovascular department to reduce the patient LoS by reducing their waiting time of imaging examinations. From the neurovascular department perspective, this thesis proposes a new MRI examinations reservation process in order to reduce patient waiting times without degrading the utilization of MRI. The service provider, i.e., the imaging department, reserves each week a certain number of appropriately distributed contracted time slots (CTS) for the neurovascular department to ensure quick MRI examination of stroke patients. In addition to CTS, it is still possible for stroke patients to get MRI time slots through regular reservation (RTS). This thesis first proposes a stochastic programming model to simultaneously determine the contract decision, i.e., the number of CTS and its distribution, and the patient assignment policy to assign patients to either CTS or RTS. To solve this problem, structure properties of the optimal patient assignment policy for a given contract are proved by an average cost Markov decision process (MDP) approach. The contract is determined by a Monte Carlo approximation approach and then improved by local search. Computational experiments show that the proposed algorithms can efficiently solve the model. The new reservation process greatly reduces the average waiting time of stroke patients. At the same time, some CTS cannot be used for the lack of patients.To reduce the unused CTS, we further explore the possibility of the advance cancellation of CTS. Structure properties of optimal control policies for one-day and two-day advance cancellation are established separately via an average-cost MDP approach with appropriate modeling and advanced convexity concepts used in control of queueing systems. Computational experiments show that appropriate advance cancellations of CTS greatly reduce the unused CTS with nearly the same waiting times.
| Identifer | oai:union.ndltd.org:CCSD/oai:tel.archives-ouvertes.fr:tel-00566257 |
| Date | 29 April 2010 |
| Creators | Geng, Na |
| Source Sets | CCSD theses-EN-ligne, France |
| Language | English |
| Detected Language | English |
| Type | PhD thesis |
Page generated in 0.0118 seconds