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Radiotherapy pre-treatment workflow is driven by the scheduling of the first irradiation session, which is usually set right after consultation (pull strategy) or can alternatively be set after the pre-treatment workflow has been completed (push strategy). The objective of this study is to assess the impact of using pull and push strategies and explore alternative interventions for improving timeliness in radiotherapy.<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Discrete-event simulation is used to model the patient flow of a large radiotherapy department of a Dutch hospital. A staff survey, interviews with managers, and historical data from 2017 are used to generate model inputs, in which fluctuations in patient inflow and resource availability are considered.<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A hybrid (40% pull \/ 60% push) strategy representing the current practice (baseline case) leads to 12% lower average waiting times and 48% fewer first appointment rebooks when compared to a full pull strategy, which in turn leads to 41% fewer patients breaching the waiting time targets.<\/jats:p>\n                <jats:p>An additional scenario analysis performed on the baseline case showed that spreading consultation slots evenly throughout the week can provide a 21% reduction in waiting times.<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>A 100% pull strategy allows for more patients starting treatment within the waiting time targets than a hybrid strategy, in spite of slightly longer waiting times and more first appointment rebooks. Our algorithm can be used by radiotherapy policy makers to identify the optimal balance between push and pull strategies to ensure timely treatments while providing patient-centered care adapted to their specific conditions.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12911-019-0910-0","type":"journal-article","created":{"date-parts":[[2019,10,25]],"date-time":"2019-10-25T17:02:35Z","timestamp":1572022955000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Improving workflow control in radiotherapy using discrete-event simulation"],"prefix":"10.1186","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6045-9233","authenticated-orcid":false,"given":"Bruno","family":"Vieira","sequence":"first","affiliation":[]},{"given":"Derya","family":"Demirtas","sequence":"additional","affiliation":[]},{"given":"Jeroen","family":"B. van de Kamer","sequence":"additional","affiliation":[]},{"given":"Erwin W.","family":"Hans","sequence":"additional","affiliation":[]},{"given":"Wim","family":"van Harten","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2019,10,24]]},"reference":[{"issue":"4","key":"910_CR1","doi-asserted-by":"publisher","first-page":"900","DOI":"10.1016\/j.ijrobp.2012.11.004","volume":"85","author":"KM Winkfield","year":"2013","unstructured":"Winkfield KM, Gabeau D. 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At the time the study was initiated, in 2017, Dutch legislation with regard to data protection applied, in particular the Dutch Act on Data Protection of Individuals (Wet Bescherming Persoonsgegevens). Pursuant to this legislation, which was superseded by the General Data Protection Regulation (GDPR) as of 25 May 2018, this study conducted the necessary steps to comply with the applicable legislation. By rendering data anonymously, the requirements as regards the use of data have been fully complied with. Given the fact that no information about patients has been provided, no formal ethics approval was required to access the raw historical data from 2017. Clinicians (RTTs, radiation oncologists, managers, appointment schedulers) who participated in this study gave their informed verbal consent to participate, adhering to the applicable legislation, thus a written consent has been deemed unnecessary. A full-time data protection officer employed by the NKI, together with an internal auditor, verify the checks and balances of data protection in the institute. In the context of this study, they concluded that no formal ethics approval was required with regard to data use and obtaining only verbal consent from participants was sufficient to comply with the applicable legislation mentioned previously. Since all the involved individuals (patients, clinicians, RTT\u2019s, radiation oncologists, managers, logisticians) have never been identifiable during the project and the project has received a continuous monitoring with regard to data protection, this project fulfills all the necessary requirements, both at the time of the Dutch legislation and at the time of the GDPR.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"199"}}