Improve OR-schedule to reduce number of required beds

After surgery most of the surgical patients have to be admitted in a ward in the hospital. Due to financial reasons and an decreasing number of available nurses in the Netherlands over the years, it is important to reduce the bed usage as much as possible. One possible way to achieve this is to create an operating room (OR) schedule that spreads the usage of beds nicely over time, and thereby minimizes the number of required beds. An OR-schedule is given by an assignment of OR-blocks to specific days in the planning horizon and has to fulfill several resource constraints. Due to the stochastic nature of the length of stay of patients, the analytic calculation of the number of required beds for a given OR-schedule is a complex task involving the convolution of discrete distributions. In this paper, two approaches to deal with this complexity are presented. First, a heuristic approach based on local search is given, which takes into account the detailed formulation of the objective. A second approach reduces the complexity by simplifying the objective function. This allows modeling and solving the resulting problem as an ILP. Both approaches are tested on data provided by Hagaziekenhuis in the Netherlands. Furthermore, several what-if scenarios are evaluated. The computational results show that the approach that uses the simplified objective function provides better solutions to the original problem. By using this approach, the number of required beds for the considered instance of HagaZiekenhuis can be reduced by almost 20%

Optimizing Operating Room Throughput

Practice Problem: Throughput is an instrumental aspect for hospitals to maximize patient capacity; therefore, methods to improve patient flow should be consistently implemented. Surgical areas are a major contributor to inpatient admissions and the subsequent revenue; however, without the appropriate oversight, patient throughput can be negatively impacted. PICOT: The PICOT question that guided this project was: In operating room patients who require inpatient admission (P), how does the implementation of a standardized bed flow process (I), compared to the current methods for care transitions (C), reduce perioperative delays and improve hospital financial metrics (O), over a three-month period (T)? Evidence: A review of the evidence revealed that streamlining operating room throughput was essential to the quality of clinical care and patient safety as well as to improve efficiencies associated with patient volumes, lengths of stay and hospital census. Intervention: A dedicated bed flow manager was implemented in the project setting with the overall goal to enhance throughput measures within the operating room. Outcome: While the intervention did not achieve statistical significance as determined by the data analysis, the results did demonstrate clinical significance as the organization was able to maximize capacity and throughput during the Covid-19 pandemic. Conclusion: The addition of a dedicated surgical bed flow manager was beneficial to the optimization, standardization and systemization of the perioperative throughput process

NOViSE: a virtual natural orifice transluminal endoscopic surgery simulator

Purpose: Natural Orifice Transluminal Endoscopic Surgery (NOTES) is a novel technique in minimally invasive surgery whereby a flexible endoscope is inserted via a natural orifice to gain access to the abdominal cavity, leaving no external scars. This innovative use of flexible endoscopy creates many new challenges and is associated with a steep learning curve for clinicians. Methods: We developed NOViSE - the first force-feedback enabled virtual reality simulator for NOTES training supporting a flexible endoscope. The haptic device is custom built and the behaviour of the virtual flexible endoscope is based on an established theoretical framework – the Cosserat Theory of Elastic Rods. Results: We present the application of NOViSE to the simulation of a hybrid trans-gastric cholecystectomy procedure. Preliminary results of face, content and construct validation have previously shown that NOViSE delivers the required level of realism for training of endoscopic manipulation skills specific to NOTES Conclusions: VR simulation of NOTES procedures can contribute to surgical training and improve the educational experience without putting patients at risk, raising ethical issues or requiring expensive animal or cadaver facilities. In the context of an experimental technique, NOViSE could potentially facilitate NOTES development and contribute to its wider use by keeping practitioners up to date with this novel surgical technique. NOViSE is a first prototype and the initial results indicate that it provides promising foundations for further development

Developing A Personal Decision Support Tool for Hospital Capacity Assessment and Querying

This article showcases a personal decision support tool (PDST) called HOPLITE, for performing insightful and actionable quantitative assessments of hospital capacity, to support hospital planners and health care managers. The tool is user-friendly and intuitive, automates tasks, provides instant reporting, and is extensible. It has been developed as an Excel Visual Basic for Applications (VBA) due to its perceived ease of deployment, ease of use, Office's vast installed userbase, and extensive legacy in business. The methodology developed in this article bridges the gap between mathematical theory and practice, which our inference suggests, has restricted the uptake and or development of advanced hospital planning tools and software. To the best of our knowledge, no personal decision support tool (PDST) has yet been created and installed within any existing hospital IT systems, to perform the aforementioned tasks. This article demonstrates that the development of a PDST for hospitals is viable and that optimization methods can be embedded quite simply at no cost. The results of extensive development and testing indicate that HOPLITE can automate many nuanced tasks. Furthermore, there are few limitations and only minor scalability issues with the application of free to use optimization software. The functionality that HOPLITE provides may make it easier to calibrate hospitals strategically and/or tactically to demands. It may give hospitals more control over their case-mix and their resources, helping them to operate more proactively and more efficiently.Comment: 33 pages, 11 tables, 17 figure