A new Rutgers study suggests that many of the seemingly endless and complex medical wait times can be avoided by recreating operations in a computer and testing countless potential improvements.
research in Operations Research Annual Report Researchers at Rutgers Cancer Institute and Rutgers Business School have built a working computer simulation of the institute’s blood cancer clinic and describe how they used it to identify and fix bottlenecks that caused patients to wait up to three hours between check-in and treatment.
Subsequent changes have reduced the turnaround time for blood tests in the lab from about 90 minutes to less than 30 minutes, and the clinic has nearly doubled the number of IV patients it treats per day, from about 50 to about 80.
Researchers said a similar approach could work in many medical oncology departments.
“This multi-step process for oncology patients exists at every cancer center in the country, if not the world,” said Andrew Evens, associate director for clinical services at Rutgers Cancer Institute, the state’s only National Cancer Institute-designated comprehensive cancer center, along with RWJBarnabas Health. This paper argues that this framework applies anywhere patients pass through a range of limited resources, including outpatient clinics, emergency departments, and surgical wards.
When the project began, the blood cancer clinic was treating 50 infusion patients per day, some requiring 6 to 8 hours of infusion during a 10-hour business day. These patients received care with more than 200 daily clinic visits requiring blood tests, rapid transfusions, or just a physical examination.
Cancer is difficult both mentally and physically. Therefore, we wanted to help patients move through the different phases of their visit in a very efficient and patient-centered way. ”
“We are excited to announce that the study’s senior author, Andrew Evens, is a physician-in-chief at the Jack and Cheryl Morris Cancer Center and Rutgers Cancer Institute.
Evens, who earned an executive master’s degree in business administration from Rutgers University in 2022, thought a business school approach might be helpful, so he reached out to his former professors about collaborating.
The team, led by Xin Ding from the School of Business’s Department of Supply Chain Management, embedded graduate students in clinics to record how patients actually traveled, and combined their observations with time-stamped electronic medical records that track every step from check-in to check-out.
“From there you can generate distributions and find patterns,” Ding said. “What are the patterns in which they come? What are the patterns in which they leave? And you can do that at each point in the process.”
The result was an animated three-dimensional simulation of the clinic known as a digital twin, and the model was statistically validated against months of never-before-seen real patient data. This allowed the team to test changes virtually before touching the actual clinic.
The most shocking finding was that hiring more nurses had little effect. In some simulations, the additional nurses reduced the average visit time by less than 1 minute. The real bottlenecks came from a blood sample that took 90 minutes for patients to return the results they needed to start treatment, and a single undifferentiated queue that required patients to wait 20 minutes for a blood test after an 8-hour infusion.
Simulations showed that even with a 20% increase in patient volume, having an on-site exam room and balancing appointment schedules throughout the day could reduce average visit times by 75 to 90 minutes.
The clinic brought laboratory processing to the field and created a “fast track” that separated cancer treatment from supportive care such as blood transfusions. (The clinic’s existing software supported the creation of FastTrack, but that feature was not used.) FastTrack currently continues at the Jack & Cheryl Morris Cancer Center, a 12-story, state-of-the-art, free-standing cancer hospital in New Brunswick, New Jersey, to which the institute moved last year.
Evens cautioned that other hospitals cannot simply borrow the Rutgers model because each center has a different layout and staffing.
“You can probably take some of the lessons from this article and apply them, but ultimately you’ll have to do your own analysis,” he says.
The new Morris Cancer Center building, where blood draws, doctor visits and infusions will occur on separate floors within the same building, has already created new workflow puzzles, Evens said, and he may collaborate again with the business school to solve them.
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Reference magazines:
Zhou, C. others. (2026). Enhance the efficiency and workflow of oncology outpatient services with simulation-based optimization. Operations Research Annual Report. DOI: 10.1007/s10479-026-07181-2. https://link.springer.com/article/10.1007/s10479-026-07181-2
