An open source software project for obstetrical procedure scheduling and occupancy analysis

Abstract

Increases in the rate of births via cesarean section and induced labor have led to challenging scheduling and capacity planning problems for hospital inpatient obstetrical units. We present occupancy and patient scheduling models to help address these challenges. These patient flow models can be used to explore the relationship between procedure scheduling practices and the resulting occupancy on inpatient obstetrical units such as labor and delivery and postpartum. The models capture numerous important characteristics of inpatient obstetrical patient flow such as time of day and day of week dependent arrivals and length of stay, multiple patient types and clinical interventions, and multiple patient care units with inter-unit patient transfers. We have used these models in several projects at different hospitals involving design of procedure scheduling templates and analysis of inpatient obstetrical capacity. In the development of these models, we made heavy use of open source software tools and have released the entire project as a free and open source model and software toolkit.

Taxonomic classification of planning decisions in health care: a structured review of the state of the art in OR/MS

“…The first is refusing admissions of a certain patient type when the bed census exceeds a threshold. For example, to prevent the rejection of emergent admission requests, an inpatient care unit may decide to suspend admissions of elective patients when the number of occupied beds reaches a threshold [142, 163,232,243,297,303,354,378]. As such, a certain number of beds is reserved for emergency patients.…”

Infinite-server queueing models of demand in healthcare: A review of applications and ideas for further work

“…Clearly, a "perfect" model would need to deal with this sort of nonlinearity, alongside recognition that the infinite-server formulation itself deliberately omits detailed modelling of how particular hospitals might deal with situations where demand exceeds capacity. Isken et al (2011) develop and apply methods based on the single-node results of Gallivan and Utley (2005) to tackle bed occupancy modelling and procedure scheduling for an obstetrics department consisting of four distinct units, and hence four nodes. Their formulation involves 11 patient types, each with specific requirements, and hence wellspecified routes through the four nodes, with no repeat visits.…”

“…Perhaps as a consequence of their different theoretical origins, early healthcare applications have concentrated either on emergency workloads or on elective workloads, often in single wards. However, later work has combined emergency and elective workloads and has also developed models for multiple wards in a hospital department (Isken, Ward, & Littig, 2011), whole hospital models (Helm & van Oyen, 2014), and community-based services (Utley et al, 2009).…”

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

“…The first is refusing admissions of a certain patient type when the bed census exceeds a threshold. For example, to prevent the rejection of emergent admission requests, an inpatient care unit may decide to suspend admissions of elective patients when the number of occupied beds reaches a threshold [167,189,270,285,347,355,415,443]. As such, a certain number of beds is reserved for emergency patients.…”

“…Methods: computer simulation [3,156,170,210,238,243,291,293,347,415,439,469,478,502,524], heuristics [26,501], Markov processes [46,167,249,251,296,492,493], mathematical programming [3,4,30,469], queueing theory [30,152,189,217,270,285,355,443,481] Staff-shift scheduling Shifts are hospital duties with a start and end time [74]. Shift scheduling deals with the problem of selecting what shifts are to be worked and how many employees should be assigned to each shift to meet patient demand [166,289].…”