Abstract:In this paper we consider the problem of scheduling patients in allocated surgery blocks in a Master Surgical Schedule. We pay attention to both the available surgery blocks and the bed occupancy in the hospital wards. More specifically, large probabilities of overtime in each surgery block are undesirable and costly, while large fluctuations in the number of used beds requires extra buffer capacity and makes the staff planning more challenging. The stochastic nature of surgery durations and length of stay on … Show more
“…The high frequency of process-related cancellations emphasizes the need for an improved scheduling method using patient and treatment characteristics. Innovations in scheduling may help predict the expected duration of treatment in the operating room and length of stay in downstream departments like the ICU and the ward [ 15 ], resulting in a reduction of capacity problems due to lack of ICU beds or overrun of a preceding surgery.…”
OBJECTIVES
Unanticipated cancellation of a surgical procedure is a common problem, causing distress to the patient and increases in healthcare costs. However, limited evidence exists on the effects of last-minute cancellations of cardiothoracic surgical procedures in particular. The goal of this study was to gain insight into the prevalence of and the reasons for last-minute cancellations and to examine whether cancellation is associated with adverse medical outcomes.
METHODS
Patients who were scheduled for elective cardiothoracic surgical procedures between January 2017 and June 2019 were evaluated. The reasons for the cancellations were assigned to the categories medically related or process related. We examined the differences in patient characteristics between those designated as no cancellation, medically related cancellations and process-related cancellations. Lastly, we examined the outcomes of patients who experienced a last-minute cancellation of a scheduled operation.
RESULTS
A total of 2111 patients were included; of these, 301 (14.3%) had last-minute cancellations. In 78 (26%) cases, the cancellations were attributable to medical reasons (e.g. infection, comorbidities); 215 (71%) of the cancellations were process related (e.g. another patient in more urgent need of surgery, lack of staff). Almost 99% of the operations with a process-related cancellation were rescheduled compared to only 71.8% of the medically related cancelled operations (P < 0.001). Patients with a medically related cancellation had significantly higher 1-year mortality than patients who had no cancellation (unadjusted hazard ratio 2.50; 95% confidence interval, 1.30–4.78; P = 0.006); after adjustment for the EuroSCORE II, this effect remained significant.
CONCLUSIONS
Last-minute cancellations were commonly seen in our cohort, and the reasons for cancellation were significantly related to adverse medical outcomes.
“…The high frequency of process-related cancellations emphasizes the need for an improved scheduling method using patient and treatment characteristics. Innovations in scheduling may help predict the expected duration of treatment in the operating room and length of stay in downstream departments like the ICU and the ward [ 15 ], resulting in a reduction of capacity problems due to lack of ICU beds or overrun of a preceding surgery.…”
OBJECTIVES
Unanticipated cancellation of a surgical procedure is a common problem, causing distress to the patient and increases in healthcare costs. However, limited evidence exists on the effects of last-minute cancellations of cardiothoracic surgical procedures in particular. The goal of this study was to gain insight into the prevalence of and the reasons for last-minute cancellations and to examine whether cancellation is associated with adverse medical outcomes.
METHODS
Patients who were scheduled for elective cardiothoracic surgical procedures between January 2017 and June 2019 were evaluated. The reasons for the cancellations were assigned to the categories medically related or process related. We examined the differences in patient characteristics between those designated as no cancellation, medically related cancellations and process-related cancellations. Lastly, we examined the outcomes of patients who experienced a last-minute cancellation of a scheduled operation.
RESULTS
A total of 2111 patients were included; of these, 301 (14.3%) had last-minute cancellations. In 78 (26%) cases, the cancellations were attributable to medical reasons (e.g. infection, comorbidities); 215 (71%) of the cancellations were process related (e.g. another patient in more urgent need of surgery, lack of staff). Almost 99% of the operations with a process-related cancellation were rescheduled compared to only 71.8% of the medically related cancelled operations (P < 0.001). Patients with a medically related cancellation had significantly higher 1-year mortality than patients who had no cancellation (unadjusted hazard ratio 2.50; 95% confidence interval, 1.30–4.78; P = 0.006); after adjustment for the EuroSCORE II, this effect remained significant.
CONCLUSIONS
Last-minute cancellations were commonly seen in our cohort, and the reasons for cancellation were significantly related to adverse medical outcomes.
“…𝑆𝐶1, described in (2), rewards a unit each time it is assigned to its preferred slots (preferred OT or preferred days). Meanwhile, 𝑆𝐶2, expressed in (3), penalizes the objective value for each unit assigned to a day exceeding the available quantity of movable equipment [14,80]. 𝑆𝐶3 presented in (4) rewards the objective value for not using all quantities of equipment on each day [14,80].…”
The Master Surgery Scheduling Problem (MSSP) can be described as a timetabling problem involving assigning surgery groups to operating theatre (OT) time slots. Previous MSSP optimization models considered throughput, waiting measures, resource utilization, costs, and schedule assignment objectives, neglecting consecutive days assignment preferences and surgical equipment-sharing limitations. Furthermore, previous works utilize greedy constructive heuristics to produce solutions, which increases quality but decreases feasibility. Our prior study demonstrated that the saturation degree heuristic enhances feasibility by considering assignment difficulty during event selection. However, its impact on solution quality remained unexplored. Therefore, this study proposes an improved saturation degree-based constructive heuristic that integrates objective function value for event selection to increase both quality and feasibility. The algorithm sorts surgery groups based on unit scores, prioritizing lower assignment difficulty and higher objective value. The highest-scoring group is assigned to its feasible slot with the highest slot score, following similar goals. In case of no feasible slots, the repair mechanism vacates the highest swap score slot, assessing the impact on quality and feasibility. A new mathematical model is also formulated, incorporating novel objectives regarding consecutive days assignment preference and surgical equipmentsharing limitations. Validated using real-world data from Hospital Canselor Tuanku Muhriz, the proposed algorithm is evaluated considering repair mechanism usage for feasibility and objective function value for quality. The algorithm is benchmarked against greedy, random, regret-based, and saturation degree-based constructive heuristics. Our algorithm achieved a 14.63% improvement in feasibility compared to the original variant. Its objective function value is over two times better than the closest competitor and 2.6 times superior to the original variant. Comparison with the hospital's actual plan demonstrates competitive objective function value and a more balanced waiting time distribution among surgical groups. Our study showcases that a saturation degree-based constructive heuristic considering objective function value has increased solution quality while maintaining feasibility.
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