Integrated nurse routing and rerostering in hospital-at-home

Hospital-at-home is an emerging trend that provides treatments to patients at their own homes for conditions that would otherwise require admission to hospital wards. The expected benefits of such systems range from improved patient quality of life to reduced healthcare costs. This study focuses on the operational planning decisions in hospital-at-home services. Indeed, a precise scheduling plan is required to meet the acute care needs of a fluctuating patient mix, using resources whose availability varies over time.
Given the baseline roster of the nurses and the patient's requirements, several decisions are taken simultaneously over the planning horizon: select which patients to treat at home, assign nurses to those admitted patients, sequence and schedule the care visits to build the daily tour of each nurse, and decide whether and to what extent the baseline nurse roster should be updated. The objective is first to maximize the number of patients treated at home, and second to minimize the change in the baseline roster.
A heuristic solution method is currently being developed to solve the problem, oscillating between re-rostering and routing moves, and allowing infeasible solutions to be visited. Preliminary results of the computational experiments are presented, and challenges encountered in tackling the integrated problem are discussed.