An exact approach for relating recovering surgical patient workload to the master surgical schedule

Abstract

No other department influences the workload of a hospital more than the Department of Surgery and in particular, the activities in the operating room. These activities are governed by the master surgical schedule (MSS), which states which patient types receive surgery on which day. In this paper we describe an analytical approach to project the workload for downstream departments based on this MSS. Specifically the ward occupancy distributions, patient admission/discharge distributions, and the distributions for ongoing interventions/treatments is computed. Recovering after surgery requires the support of multiple departments, such as nursing, physiotherapy, rehabilitation and long term care. With our model, managers from these departments can determine their workload by aggregating tasks associated with recovering surgical patients. The model, which supported the development of a new MSS at the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, provides the foundation for a decision support tool to relate downstream hospital departments to the operating room.

Operational research techniques applied throughout cancer care services: a review

“…At the national or regional level, OR studies have influenced decisions on screening strategies (Koleva-Kolarova et al, 2015), cervical screening processes (Pilgrim and Chilcott, 2008) and funding of anti-cancer proposals (Hall et al, 1992). At the hospital or department level, OR studies have impacted brachytherapy delivery (Lee & Zaider, 2008), surgical schedules (Vanberkel et al, 2011), chemotherapy booking practices and schedules (Santibáñez et al, 2012), nurse hiring and shift start times and cancer treatment centre capacity, layout and scheduling processes (Matta & Patterson, 2007). Additionally, Simon (2009) developed a treatment decision aid that is accessible online.…”

“…Their case study, optimising the schedules of plastic and oncologic surgeons, succeeded in increasing the number of sessions when teams of two surgeons were available for breast cancer surgery by 94%. Vanberkel et al (2011), on the other hand, compare surgical block schedules, that is, which blocks of operating room time are assigned to different specialties. They use an analytic approach involving queuing theory to output the workload in different wards created by patients recovering from surgery.…”

Integrated decision making in healthcare : an operations research and management science perspective

“…Capacity allocation decisions in surgical care services impact the performance of downstream inpatient care services [31,33,49,84,130,336,403,491,492,493]. Variability in bed utilization and staff requirements can be decreased by incorporating information about the required inpatient beds for surgical cases in allocating surgical capacity [4,31,33,217,428,487,488].…”

“…Methods: computer simulation [57,140,143,144,307,396,533], heuristics [31,32,33,462,501], Markov processes [196,492,493,536] Temporary capacity change. Available resource capacity could be temporarily changed in response to fluctuations in demand [334].…”

“…For many inpatient care services the authority on admission control is limited due to the high dependency on the operating room schedule (see surgical care services). By adjusting the surgical schedule, extremely busy and slack periods can be avoided [4,26,152,156,170,210,217,238,469,492,493,501,502,524] and cancellation of elective surgeries can be avoided [291]. In practice, the operating room planning is generally done under the assumption that a free bed is available for postoperative care [293], which may result in surgery cancellations.…”