Using mathematical modelling to schedule dialysis treatment effectively

Background:

Hospital-based dialysis usually requires patients to attend three times per week for 3-4 hours at a time. Most patients also require transport services to convey them to and from treatment.

The ‘Dialysis reMix’ project emerged during the inaugural Welsh Health Hack in 2017. An intriguing presentation by Dr Daniel Gartner demonstrated how LEGO and a mathematical modelling programme, can be the answer to many of the challenges in which we face in the health service.

The number of people with renal disease is increasing year-on-year and there is an expectation to meet the demand for treatment, which is becoming difficult to manage with limited resource and capacity. Applying mathematical modelling to dialysis treatment scheduling seemed like an obvious solution that potentially could benefit all involved.

Aims:

In this project, the goal is to more effectively schedule dialysis sessions by planning patient treatment based on their individual session pattern.

The team models the problem using mathematical programming to implement a Decision Support System (DSS), that allows them to consider a variety of different constraints such as patient demand, dialysis resource including staffing, as well as transport requirements and availability.

Using the Decision Support System, demand forecasts will be extracted from Vital Data (consolidated electronic record) in order to aid decision making to maximise resources more effectively.

Challenges:

Engaging with stakeholders has been the most significant challenge, as there were so many professionals involved and this project entailed making changes to a number of in-house practices which have been in place for many years.

It was important to listen and learn from each other’s experiences and perspectives in a way which has not been done before. The opportunity to share a grand vision with key decision makers has been key to the progress of the project and co-production will be pivotal to its ongoing success.

Outcomes:

The ultimate goal is for patients to experience a seamless treatment schedule. This would include a number of elements such as:

• Routine bespoke appointment times, which will reduce unnecessary waiting times before and after treatment, leading to an overall better experience for each patient.
• Collaborative approach by all stakeholders, to communicate and co-ordinate effectively by using the most appropriate technology and data available.
• Transparency and ability to view an ‘Alive’ view of activity, which can be coordinated centrally.
• Staff embracing technology and data to help manage their workload efficiently leading to more time spent with patients.

Next steps:

Successful implementation of the project within our units would likely see adoption of the system across the other dialysis units across the region initially, then nationally. Adoption at national level would allow for centralised coordination of services and open the door for future enhanced services as well as a reduction in inappropriate variation across the nation.

This project is a small yet important element of a wider transformation programme for Renal Services, which is pushing boundaries and questioning the status quo.