Master surgery scheduling with consideration of multiple downstream units

With increasing organizational and financial pressure on hospitals, each individual surgical treatment has to be reviewed and planned thoroughly. Apart from the expensive operating room facilities, proper staffing and planning of downstream units, like the wards or the intensive care units (ICUs), should be considered as well. In this article, we outline the relationship between a master surgery schedule (MSS), i.e., the assignment of surgical blocks to medical specialties, and the bed demand in the downstream units using an analytical model. By using historical data retrieved from the clinical information system and a patient flow model, we applied a recently developed algorithm for predicting bed demand based on the MSSs for patients of 3 surgical subspecialties of a hospital. Simulations with 3 different MSSs were performed. The impact on the required amount of beds in the downstream units was analyzed. We show the potential improvements of the current MSS considering 2 main goals: leveling workload among days and reduction of weekend utilization. We discuss 2 different MSSs, one decreasing the weekend ICU utilization by 20% and the other one reducing maximum ward bed demand by 7%. A test with 12 months of real-life data validates the results. The application of the algorithm provides detailed insights for the hospital into the impact of MSS designs on the bed demand in downstream units. It allowed creating MSSs that avoid peaks in bed demand and high weekend occupancy levels in the ICU and the ward.

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“…15 The hospital runs 36 ORs on a daily basis. The ORs are located in several decentralized OR suites.…”

Section: Methodsmentioning

confidence: 99%

Improving Intensive Care Unit and Ward Utilization by Adapting Master Surgery Schedules

et al. 2016

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“…Fügener et al [35] consider the impact of the MSS on the downstream resources such as the intensive care unit (ICU) and the general wards. The authors first present an exact stochasatic MSS approach to calculating patients occupancy distributions in the ICU and multiple wards and then present exact and heuristic algorithms to minimize costs resulting from the patients in the downstream units.…”

Section: Mathematical Programming Based Approachmentioning

confidence: 99%

Scheduling elective surgeries: the tradeoff among bed capacity, waiting patients and operating room utilization using goal programming

Rafaliya²,

Baki

et al. 2015

Health Care Manag Sci

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Scheduling of surgeries in the operating rooms under limited competing resources such as surgical and nursing staff, anesthesiologist, medical equipment, and recovery beds in surgical wards is a complicated process. A well-designed schedule should be concerned with the welfare of the entire system by allocating the available resources in an efficient and effective manner. In this paper, we develop an integer linear programming model in a manner useful for multiple goals for optimally scheduling elective surgeries based on the availability of surgeons and operating rooms over a time horizon. In particular, the model is concerned with the minimization of the following important goals: (1) the anticipated number of patients waiting for service; (2) the underutilization of operating room time; (3) the maximum expected number of patients in the recovery unit; and (4) the expected range (the difference between maximum and minimum expected number) of patients in the recovery unit. We develop two goal programming (GP) models: lexicographic GP model and weighted GP model. The lexicographic GP model schedules operating rooms when various preemptive priority levels are given to these four goals. A numerical study is conducted to illustrate the optimal master-surgery schedule obtained from the models. The numerical results demonstrate that when the available number of surgeons and operating rooms is known without error over the planning horizon, the proposed models can produce good schedules and priority levels and preference weights of four goals affect the resulting schedules. The results quantify the tradeoffs that must take place as the preemptive-weights of the four goals are changed.

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“…This comes as no surprise as around 40 % of hospital expenses arise in the operating theater [13] and more than 60 % of hospital admissions are for surgical operations [38]. Furthermore, processes in downstream units, such as intensive care units or general wards, are triggered by the OR department [21][22][23]. Although the high importance of optimizing the usage of this scarce resource is evident, there still is much room for improvement.…”

Section: Introductionmentioning

confidence: 97%

Overutilization and underutilization of operating rooms - insights from behavioral health care operations management

Fügener

Schiffels

Kolisch

2015

Health Care Manag Sci

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The planning of surgery durations is crucial for efficient usage of operating theaters. Both planning too long and too short durations for surgeries lead to undesirable consequences, e.g. idle time, overtime, or rescheduling of surgeries. We define these consequences as operating room inefficiency. The overall objective of planning surgery durations is to minimize expected operating room inefficiency, since surgery durations are stochastic. While most health care studies assume economically rational behavior of decision makers, experimental studies have shown that decision makers often do not act according to economic incentives. Based on insights from health care operations management, medical decision making, behavioral operations management, as well as empirical observations, we derive hypotheses that surgeons' behavior deviates from economically rational behavior. To investigate this, we undertake an experimental study where experienced surgeons are asked to plan surgeries with uncertain durations. We discover systematic deviations from optimal decision making and offer behavioral explanations for the observed biases. Our research provides new insights to tackle a major problem in hospitals, i.e. low operating room utilization going along with staff overtime.

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Master surgery scheduling with consideration of multiple downstream units

Cited by 118 publications

References 20 publications

Improving Intensive Care Unit and Ward Utilization by Adapting Master Surgery Schedules

Improving Intensive Care Unit and Ward Utilization by Adapting Master Surgery Schedules

Scheduling elective surgeries: the tradeoff among bed capacity, waiting patients and operating room utilization using goal programming

Overutilization and underutilization of operating rooms - insights from behavioral health care operations management

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