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ADVANACED SCHEDULING OPTIMIZATION

Case Study

The Challenge:

To improve the efficiency of their home health clinical team comprised of nurses, rehab therapists, social workers and home health aides. The home health scheduling problem is a complex one that involves physician’s orders for each type of visit as well as time constraints, and staffing constraints. At this health system they generally service 400 patients at a time for episodes of care normally ranging up to 60 days after a hospital discharge.

Prior to the implementation of Ankota, some of their most talented clinical staff spends the majority of their day making scheduling decisions. notifying clients when they will be coming to their homes and plotting their routes to see their six patients for the day. These talented professionals should be spending their time applying their craft of nursing or therapy. The health system turned to Ankota to solve the problem.

The Solution:

The solution involves choosing the best clinician to perform each patient visit based on the required skills, worker availability, and geography. While a lot of this is straightforward algorithmic decision making, there are conflicting requirements. For example, continuity of care is very important and whenever possible the assigned Registered Nurse (RN) case manager would be a great choice to treat any of their patients for any nursing need. But at the same time, if these nurse’s calendars are filled up with the more basic skilled nursing, wound care and lab activities, they might not be available for the tougher skilled visits like lab cases requiring intravenous draws or enteral-ostomal therapy activities. So, while continuity of care is important, decisions need to be overturned and visits need to be reassigned to Licensed Practical Nurses (LPNs). There are many trade-offs made each day and all of them have conflicting requirements.

Yet another area where Ankota is helping is by automating the process of informing and confirming visits. Even after making great assignments and routes that are optimal for both clinicians and patients, some patients will reject their appointments or be unable to be home due to doctor's appointments or re-hospitalizations.

As such, the system and schedule are almost like living and breathing entities, and the system is trying to get all of the work done, minimize driving, minimize the number of visits that require manual decisions to be made, and maximize the number of patients whose visits can be confirmed without a live phone call. Each one of these tasks that can be achieved through the Ankota advanced scheduling algorithm ends up reducing the overhead costs and enabling their professional clinical staff to spend more time on providing the best possible care.

Here is a high level overview of some of the steps followed by the Ankota Advanced Scheduling algorithm:

  1. 3-Step Process to Create the Selection Pool

  2. 5-Step Selection Rules.

  3. 7-Step Timing Algorithm.

  4. 6 Special Business Rules Appli“Assigned and timed” visits.

    • Processing excludes visits for today and for tomorrow.
    • All “TV” visits are ignored.
    • Workers can be case loaded based on both a point scale and by customized availability.
    • BSNIV, BSNIVLAB, BSNLAB, BSNRN and BSNVAC must be assigned prior to a BSN.
      • Visit types will be given a priority.
      • Scheduling will be based on priority.
      • Rescheduling will occur no less than 24 hours out.
      • Lesser priority visits will be removed if needed.
    • BPTE requires a BSNO prior to being scheduled BSNO AND BSNIVO before BPTE, BOTE, BSTE.
    • If BPTE with no BSNO scheduled, put on “Uncovered Team “X””.
    • If BPTE with BSNO scheduled, proceed with scheduling.
    • BPTE must be scheduled AFTER the BSNO, even in the same day.
  5. And one more thing, workers have the ability to flip their schedules and start their day with their last visit.