Integrating nurse and surgery scheduling.

Scheduling; Surgery scheduling; International; Theory; Applications; Euro; Researchers;

Integral resource capacity planning for inpatient care services based on hourly bed census predictions

The design and operations of inpatient care facilities are typically largely historically shaped. A better match with the changing environment is often possible, and even inevitable due to the pressure on hospital budgets. Effectively organizing inpatient care requires simultaneous consideration of several interrelated planning issues. Also, coordination with upstream departments like the operating theater and the emergency department is much-needed. We present a generic analytical approach to predict bed census on nursing wards by hour, as a function of the Master Surgical Schedule (MSS) and arrival patterns of emergency patients. Along these predictions, insight is gained on the impact of strategic (i.e., case mix, care unit size, care unit partitioning), tactical (i.e., allocation of operating room time, misplacement rules), and operational decisions (i.e., time of admission/discharge). The method is used in the Academic Medical Center Amsterdam as a decision support tool in a complete redesign of the inpatient care operations

Robust Optimization Framework to Operating Room Planning and Scheduling in Stochastic Environment

Arrangement of surgical activities can be classified as a three-level process that directly impacts the overall performance of a healthcare system. The goal of this dissertation is to study hierarchical planning and scheduling problems of operating room (OR) departments that arise in a publicly funded hospital. Uncertainty in surgery durations and patient arrivals, the existence of multiple resources and competing performance measures are among the important aspect of OR problems in practice. While planning can be viewed as the compromise of supply and demand within the strategic and tactical stages, scheduling is referred to the development of a detailed timetable that determines operational daily assignment of individual cases. Therefore, it is worthwhile to put effort in optimization of OR planning and surgical scheduling. We have considered several extensions of previous models and described several real-world applications. Firstly, we have developed a novel transformation framework for the robust optimization (RO) method to be used as a generalized approach to overcome the drawback of conventional RO approach owing to its difficulty in obtaining information regarding numerous control variable terms as well as added extra variables and constraints into the model in transforming deterministic models into the robust form. We have determined an optimal case mix planning for a given set of specialties for a single operating room department using the proposed standard RO framework. In this case-mix planning problem, demands for elective and emergency surgery are considered to be random variables realized over a set of probabilistic scenarios. A deterministic and a two-stage stochastic recourse programming model is also developed for the uncertain surgery case mix planning to demonstrate the applicability of the proposed RO models. The objective is to minimize the expected total loss incurred due to postponed and unmet demand as well as the underutilization costs. We have shown that the optimum solution can be found in polynomial time. Secondly, the tactical and operational level decision of OR block scheduling and advance scheduling problems are considered simultaneously to overcome the drawback of current literature in addressing these problems in isolation. We have focused on a hybrid master surgery scheduling (MSS) and surgical case assignment (SCA) problem under the assumption that both surgery durations and emergency arrivals follow probability distributions defined over a discrete set of scenarios. We have developed an integrated robust MSS and SCA model using the proposed standard transformation framework and determined the allocation of surgical specialties to the ORs as well as the assignment of surgeries within each specialty to the corresponding ORs in a coordinated way to minimize the costs associated with patients waiting time and hospital resource utilization. To demonstrate the usefulness and applicability of the two proposed models, a simulation study is carried utilizing data provided by Windsor Regional Hospital (WRH). The simulation results demonstrate that the two proposed models can mitigate the existing variability in parameter uncertainty. This provides a more reliable decision tool for the OR managers while limiting the negative impact of waiting time to the patients as well as welfare loss to the hospital

Operating room planning and scheduling: A literature review.

This paper provides a review of recent research on operating room planning and scheduling. We evaluate the literature on multiple fields that are related to either the problem setting (e.g. performance measures or patient classes) or the technical features (e.g. solution technique or uncertainty incorporation). Since papers are pooled and evaluated in various ways, a diversified and detailed overview is obtained that facilitates the identification of manuscripts related to the reader's specific interests. Throughout the literature review, we summarize the significant trends in research on operating room planning and scheduling and we identify areas that need to be addressed in the future.Health care; Operating room; Scheduling; Planning; Literature review;

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

We provide a structured overview of the typical decisions to be made in resource capacity planning and control in health care, and a review of relevant OR/MS articles for each planning decision. The contribution of this paper is twofold. First, to position the planning decisions, a taxonomy is presented. This taxonomy provides health care managers and OR/MS researchers with a method to identify, break down and classify planning and control decisions. Second, following the taxonomy, for six health care services, we provide an exhaustive specification of planning and control decisions in resource capacity planning and control. For each planning and control decision, we structurally review the key OR/MS articles and the OR/MS methods and techniques that are applied in the literature to support decision making

Optimizing a multiple objective surgical case scheduling problem.

The scheduling of the operating theater on a daily base is a complicated task and is mainly based on the experience of the human planner. This, however, does not mean that this task can be seen as unimportant since the schedule of individual surgeries influences a medical department as a whole. Based on practical suggestions of the planner and on real-life constraints, we will formulate a multiple objective optimization model in order to facilitate this decision process. We will show that this optimization problem is NP-hard and hence hard to solve. Both exact and heuristic algorithms, based on integer programming and on implicit enumeration (branch-and-bound), will be introduced. These solution approaches will be thoroughly tested on a realistic test set using data of the surgical day-care center at the university hospital Gasthuisberg in Leuven (Belgium). Finally, results will be analyzed and conclusions will be formulated.Algorithms; Belgium; Branch-and-bound; Constraint; Data; Decision; Experience; Healthcare; Heuristic; Integer; Integer programming; Model; Optimization; Order; Processes; Real life; Scheduling; University;

Stochastic master surgery scheduling

The aim of the Master Surgery Scheduling Problem (MSSP) is to schedule the medical specialties to the different operating rooms available, such that surgeries may be performed efficiently. We consider a MSSP where elective and emergency patients can be treated in the same operating rooms. In addition to elective-dedicated operating room slots, flexible operating room slots are introduced to handle the fluctuating demand of emergency patients. To solve the MSSP, we propose a simulation-optimization approach consisting of a two-stage stochastic optimization model and a discrete-event simulation model. For the two-stage stochastic optimization model, uncertain arrivals of emergency patients are represented by discrete scenarios. The discrete-event simulation model is developed to address uncertainty related to the surgery duration and the length of stay at the hospital, and to test the Master Surgery Schedule (MSS) developed by the optimization model in a stochastic operational-level environment. In addition, the simulation model is used to generate scenarios for the optimization model. We present some general advice for surgery scheduling based on testing the optimization model in a numerical study. The simulation-optimization approach is applied to a case study from a hospital department that treats both elective and emergency patients. The optimized MSS outperforms the manually generated MSS, both in terms of emergency waiting time for surgery, and emergency interruptions to the flow of electives.acceptedVersio