New Rutgers research suggests much of the seemingly endless waiting for complex medical care can be engineered away by recreating operations inside a computer and testing countless possible improvements.
A study in the Annals of Operations Research explains how researchers from Rutgers Cancer Institute and Rutgers Business School built a working computer simulation of the institute's blood cancer clinic and used it to identify and fix bottlenecks that kept patients waiting up to three hours between check-in and treatment.
The changes that followed cut laboratory blood work turnaround from roughly 90 minutes to less than 30 and helped the clinic nearly double the number of infusion patients it treats each day, from about 50 to about 80.
The researchers said the same approach could work at many medical oncology offices.
"The multistep process for oncology patients exists at every cancer center in the country, if not the world," said Andrew Evens , deputy director for clinical services at Rutgers Cancer Institute, the state's only National Cancer Institute-designated Comprehensive Cancer Center, together with RWJBarnabas Health. The paper argues the framework applies wherever patients flow through a sequence of constrained resources, including outpatient clinics, emergency departments and surgical units.
When the project began, the blood-cancer clinic treated 50 infusion patients a day, some requiring 6- to 8-hour infusions within a 10-hour operating day. These patients received care alongside more than 200 daily clinic visits who needed only a blood check, a quick transfusion or a consultation.
"Cancer is difficult, emotionally and physically," said Evens, a senior author of the study and Chief Physician Officer of the Jack & Sheryl Morris Cancer Center and Rutgers Cancer Institute. "So, we wanted to make sure patients were able to go through these different junctures of their visit in a very efficient and patient-centered way."
Evens, who completed an executive master of business administration degree at Rutgers in 2022, thought the business school approach could help, so he reached out to his former professors about a collaboration.
A team led by Xin Ding of the business school's Department of Supply Chain Management embedded graduate students in the clinic to log how patients actually moved through, then combined those observations with timestamped electronic health records tracking every step from check-in to checkout.
"From there, we can generate distributions and find patterns," Ding said. "What is the pattern for them to come? What is the pattern for them to leave? And we can do that for each point of the process."
The result was an animated, three-dimensional simulation of the clinic known as a digital twin, statistically validated against months of real patient data the model had never seen, that let the team test changes virtually before anyone touched the real clinic.
The most striking finding was that adding nurses would do little good. In some simulations, an additional nurse shaved less than a minute off the average visit. The real bottlenecks stemmed from blood samples sent to an off-site hospital laboratory that took 90 minutes to return the results patients needed to start treatment and a single undifferentiated queue that made a 20-minute blood-check wait behind an eight-hour infusion.
The simulation showed that an on-site laboratory and balancing the appointment schedule throughout the day would cut average visit times by 75 to 90 minutes, even if patient volume increased 20%.
The clinic brought laboratory processing on-site and created a "fast track" that separates cancer treatment from supportive care such as transfusions. (The clinic's existing software supported the creation of the fast track, but the feature had gone unused.) The fast track continues today at the Jack & Sheryl Morris Cancer Center , the 12-story, state-of-the-art freestanding cancer hospital in New Brunswick, N.J., the institute moved into last year.
Evens cautioned that other hospitals cannot simply borrow the Rutgers model, since every center differs in layout and staffing.
"You could probably take some learned lessons from this article and apply them, but at the end of the day, you're going to need to do your own analysis," he said.
The new Morris Cancer Center building, with blood draws, doctor visits and infusions now on separate floors in the same building, has already created fresh workflow puzzles – and Evens said they may re-engage the business school to solve them.
