Determining the Number of Beds in the Postanesthesia Care Unit: A Computer Simulation Flow Approach

Abstract

Designing new operating room (OR) facilities implies many decisions on the number of ORs, postanesthesia care unit (PACU) beds, and on the staff of nurses and porters. To make these decisions, managers can use rules of thumb or recommendations. Our study highlights the interest of using flow simulation to validate these choices. In this case study we determine the number of PACU beds and porter staff and assess the impact of decreasing the number of porters on PACU bed requirements.

Operating room planning and scheduling: A literature review

“…In Section 3 we already introduced the example by Adan and Vissers [1] in which the deviation between the target utilization of resources such as the ICU staff, ICU beds or regular ward beds [25,26,60,78,85] throughput [3,5,20,53,64,103,104,109,115] [18,20,49,64] leveling operating room [8,42,84,85,89] ward [7,6,9,62,103,108,114] PACU [8,21,22,66,82,83] holding area [83] patient volume [89,108] makespan [51,52,66,82,93,98] patient deferral / refusal [2,17,…”

“…Second, we identify precedence constraints or constraints related to time lags. Due to contamination risks, for instance, it is obliged to schedule infected patients at the end of the surgery day or to insert idle time between surgeries which allows for an extended cleaning of the operating room [21,22,85]. A third category consists of constraints related to certain release or due dates, whereas a fourth and last category represents the demand-related constraints.…”

“…Pham and Klinkert [98], for instance, incorporate all but demand-related constraints in their surgical case scheduling problem. They model their optimization problem as a multi-mode blocking job shop problem and develop [25,93,102,116,117] precedence constraints/time lags [21,22,67,85,89,96,98,111] release / due date constraints [23, a MIP formulation to minimize performance criteria such as the resulting makespan or the incurred operating room overtime. Each job or surgery is described as a predetermined sequence of activities and a maximum allowed waiting time between the processing of two consecutive activities is specified (precedence and time lag).…”

Review article: Simulation in anesthesia: state of the science and looking forward

“…8,19,21,22 More recently, the use of simulation in anesthesia has broadened to include the acquisition of technical skills (e.g., fibreoptic oral intubations and cricothyroidotomies), [23][24][25][26] the study of performance-shaping factors and performance gaps, 27-34 the evaluation of new equipment, 35 and modelling patient flow in clinical settings. 36,37 Simulation for training: state of the science…”

Operating theatre scheduling with patient recovery in both operating rooms and recovery beds

“…A hybrid genetic algorithm was proposed to solve the problem. Marcon et al (2003) [14] developed a simulation model to find an optimal scheduling strategy, taking into account the whole surgery process. A mathematical model is proposed to minimize the overtime for operating rooms.…”