Planning and scheduling of operating theater under resources constraints: State of the art and future trends and impact on energy consumption

The management of operating theaters is currently the subject of considerable discussion, particularly with regard to the use of human and material resources, which are available in limited quantities. The first part of this paper deals with the management of hospital systems and operating theaters. In the second part, we review the main studies on planning surgical procedures under resources constraints, as well as the different methods for solving planning and scheduling problems in operating theaters. A comparative analysis is carried out in order to identify the fundamental ideas leading to the adoption of a new model capable of meeting the needs and satisfying the different constraints of this management. This article shows that planning and scheduling play a major role in the management of an operating theater, which remains difficult given the multiplicity of determinants involved. In this work, we describe the problem of planning and scheduling operating theaters according to several authors, aiming to evaluate and improve existing operating programs to make them feasible and of good quality. The depletion of the world’s available energy resources requires the construction of hospital buildings that respect the environment and take into account energy efficiency while meeting different needs

TRADE-OFF BALANCING FOR STABLE AND SUSTAINABLE OPERATING ROOM SCHEDULING

The implementation of the mandatory alternative payment model (APM) guarantees savings for Medicare regardless of participant hospitals ability for reducing spending that shifts the cost minimization burden from insurers onto the hospital administrators. Surgical interventions account for more than 30% and 40% of hospitals total cost and total revenue, respectively, with a cost structure consisting of nearly 56% direct cost, thus, large cost reduction is possible through efficient operation management. However, optimizing operating rooms (ORs) schedules is extraordinarily challenging due to the complexities involved in the process. We present new algorithms and managerial guidelines to address the problem of OR planning and scheduling with disturbances in demand and case times, and inconsistencies among the performance measures. We also present an extension of these algorithms that addresses production scheduling for sustainability. We demonstrate the effectiveness and efficiency of these algorithms via simulation and statistical analyses

Local search for the surgery admission planning problem

We present a model for the surgery admission planning problem, and a meta-heuristic algorithm for solving it. The problem involves assigning operating rooms and dates to a set of elective surgeries, as well as scheduling the surgeries of each day and room. Simultaneously, a schedule is created for each surgeon to avoid double bookings. The presented algorithm uses simple Relocate and Two-Exchange neighbourhoods, governed by an iterated local search framework. The problem's search space associated with these move operators is analysed for three typical fitness surfaces, representing different compromises between patient waiting time, surgeon overtime, and waiting time for children in the morning on the day of surgery. The analysis shows that for the same problem instances, the different objectives give fitness surfaces with quite different characteristics. We present computational results for a set of benchmarks that are based on the admission planning problem in a chosen Norwegian hospital

Operating theatre planning and scheduling in real-life settings.Problem analysis, models, and solution procedures

Falta palabras claveNowadays health care organizations experience an increasing pressure in order to provide their services at the lowest possible costs as a response to the combination of restrictive budgets, increasing waiting lists, and the aging of the population. In general, hospital resources are expensive and scarce, being the operating theatre the most critical and expensive resource. In most hospitals, the operating theatre is a complex system composed of operating rooms (ORs) together with their specialized equipment, preoperative and postoperative facilities and, finally, a diversity of human resources, including surgeons, anesthetists, nurses, etc. To handle such complexity, decisions related to operating theatre management are usually decomposed into three hierarchical decision levels, i.e.: strategic, tactical and operational. At the strategic level, hospital managers set the volume and the mix of surgeries that will be performed over a long-term horizon (typically, a year) to keep up acceptable size of waiting lists while achieving cost targets, thus making long-term decisions related to the dimensioning of surgical facilities (e.g. build new ORs, adding new recovery beds, etc.), the hiring of surgical staff (e.g. surgeons, nurses, etc.), the purchase of novel surgical devices, and the amount of operating theatre resources required by surgical specialties to perform their surgeries (OR time, number of beds, etc.). Once decisions at strategic level have been made, the operating theatre resources are allocated over a medium-term planning horizon (ranging from few weeks to 6 months) in the tactical level. Since the OR is both a bottleneck and the most expensive facility for most hospitals, surgical specialties are first assigned to OR days (i.e. a pair of an OR and a day) over the planning horizon, until the OR time allocated to each surgical specialty in the strategic level is reached. Then, the above assignment defines aggregate resource requirements for specialties, such as the demand of nurses, drugs, diagnostic procedures, laboratory tests, etc. Finally, the working shifts of human resources and their workload (e.g. the number of surgeries allocated to each surgeon) are defined over the medium-term planning horizon in order to achieve the volume of surgeries set by hospital managers. Finally, the surgical schedule is determined over a short-term planning horizon (ranging from few days to few weeks) at the operational level. The operational level is usually solved into two steps. The first step involves the determination of the date and the OR for a set of surgeries in the waiting list; while in the second step, a sequence of surgeries for each OR within each day in the planning horizon is obtained. Note that only a set of surgeries will be performed during the planning horizon due to capacity constraints (both facilities and human resources). The decomposition of the operational level into the two aforementioned steps intends to reduce the complexity of the resulting problem, although the quality of the so-obtained surgery schedule may be reduced due to the high interdependence among these two steps, being the integrated approach a popular topic of research. At the operational level, a feature greatly influencing the performance is the uncertainty in the surgical activities, as frequently large discrepancies between the scheduled duration and the real duration of the surgeries appear, together with the availability of the resources reserved for emergency arrivals. Despite the importance and the complexity of these hierarchical levels, decisions in practice are usually made according to the decision makers’ experience without considering the underlying optimization problems. Furthermore, the lack of usage of decision models and solution procedures causes the decision makers to consume long times on performing management tasks (e.g. determine the surgical schedule, react to unforeseen events, carry out what-if analyses, etc.), instead of healthcare tasks. The context discussed above stresses the need to provide healthcare decision makers with advanced operations research techniques (i.e. models and solution procedures) in order to improve the efficiency of the operating theatre resources and the quality of the healthcare services at the operational level. This Thesis is aimed at this goal

Decision support systems for task scheduling: applications in manufacturing and healthcare

Esta Tesis se centra en el problema de la programación de tareas. Aunque pueden encontrarse diferentes definiciones de la programación de tareas en la literatura, aquí se define como la asignación de un número de tareas – acciones individuales que deben realizarse para completar un determinado proceso-, a un conjunto de recursos, en momentos de tiempo específicos. Pueden encontrarse ejemplos de programación de tareas en muchos contextos, como por ejemplo, el orden en el que deben fabricarse las diferentes partes de un coche, la asignación de quirófanos y cirujanos a intervenciones quirúrgicas en un hospital, o el orden en el que deben ser servidos los clientes de un restaurante. La programación de tareas supone un elemento clave en muchas compañías, en el campo de los servicios y en el de la fabricación, ya que es esencial para la coordinación del trabajo entre los diferentes actores involucrados, tales como departamentos, recursos (físicos y humanos) o entidades externas. En la mayoría de los casos, la programación de tareas conlleva trabajar con grandes cantidades de datos relacionados con el proceso y gestionar correctamente el conjunto de restricciones que controlan el proceso. Como consecuencia de esto, la programación de tareas suele hacerse con ayuda de herramientas informáticas que ofrecen algún tipo de soporte para el decisor. A este respecto, el auge de las Tecnologías de la Información (TI) en las últimas décadas ha ayudado enormemente al desarrollo de sistemas computarizados que ofrecen soporte a la toma de decisiones – Sistemas de Soporte a la Decisión (SSD) – en muchos ámbitos, incluyendo la programación de tareas. Además, ha habido un notable aumento en la capacidad computacional que ha hecho posible afrontar problemas de programación de tareas que se consideraban irresolubles hace algunos años. A pesar de estos avances, se ha detectado un gap entre teoría y práctica al llevar estas nuevas condiciones a la práctica, que puede ser demostrado por el limitado número de sistemas que se han implementado y aceptado por los usuarios satisfactoriamente. La hipótesis de trabajo de esta Tesis es que, para reducir este gap entre teoría y práctica, estos sistemas deberían considerar un conjunto de aspectos que se han estudiado en la literatura pero que no se han tenido en cuenta en el proceso de implementación, tales como el rol del decisor en el sistema, el contexto organizacional donde se toman las decisiones para la programación o la consideración de la programación como un proceso dinámico. Normalmente, cada vez que una empresa necesita implementar un SSD para la programación de tareas (SSDPT), es posible elegir entre dos opciones: adquirir una solución off-the-shelf, o diseñar y desarrollar una herramienta personalizada. Cuando se elige la primera opción, normalmente la solución no se adapta perfectamente a las actividades de la empresa, y considerando que la programación de tareas es muy dependiente del contexto, esta opción puede resultar en una situación muy documentada en la literatura en la que se consigue una implementación muy limitada en la que hay diferentes sistemas de información trabajando en paralelo para tener en cuenta las diferentes especificidades de la empresa. Por otro lado, si se opta por la segunda opción, esta suele derivar en largos tiempos de implementación con resultados pobres, ya que el equipo de desarrollo podría no tener en cuenta los errores y aciertos de otras implementaciones, tales como las funcionalidades que un sistema debería tener o los perfiles que se debería dar a los diferentes usuarios. Como resumen podríamos decir que el diseño y la implementación de SSDPT tienen un conjunto de problemas que constituyes una de las principales causas del gap existente entre la teoría de la programación de tareas y su implementación en la práctica. Para mejorar la actividad de diseño y desarrollo de SSDPT, el objetivo de esta tesis es proponer un framework común para el desarrollo de SSDPT. Para asegurar su validez y analizar su rango de aplicación, se analiza su factibilidad en dos sectores de aplicación, fabricación y salud, y se llevan a cabo dos casos de estudio en estos sectores. Para conseguir el objetivo general de la Tesis, se consideran un conjunto de objetivos específicos: 1. Proponer un framework para el diseño y desarrollo de SSDPT. • El framework tiene en cuenta todos los problemas detectados en la literatura que tienen que ver con los fallo a la hora de implementar este tipo de sistemas. Este framework se detalla mediante un conjunto de perspectivas. 2. Analizar las implementaciones existentes de SSDPT para analizar la alineación del framework propuesto con las implementaciones existentes de este tipo de sistemas en los dos campos de aplicación. • Se lleva a cabo una revisión sistemática de la literatura en SSDPT en fabricación. Las contribuciones revisadas se clasifican de acuerdo a las funcionalidades que presentan. Se analizan y discuten una serie de resultados y conclusiones de los mismos. Además se realiza una revisión de SSDPT comerciales para la programación de quirófanos. Estas contribuciones también se clasifican según sus funcionalidades y se presentan y discuten una serie de resultados y conclusiones. 3. Levar a cabo el diseño e implementación de dos SSDPT de acuerdo con el framework propuesto para demostrar su validez. • Basándonos en el framework un SSDPT para fabricación y un SSDPT para la programación de quirófanos han sido propuestos: i. El SSDPT para fabricación se implementó para una empresa de fabricación situada en Sevilla. Primero se describe el contexto en el que el sistema actúa y el problema considerado. Después se estudian los principales casos de uso del sistema y se relacionan con el framework propuesto. Más tarde, se proponen una serie de métodos de resolución eficientes para el problema analizado. Finalmente, se realiza una breve discusión sobre los principales resultados de implementación del sistema. ii. El SSDPT para programación de quirófanos se implementó en un hospital situado en Sevilla. Primero se describe el contexto en el que el sistema actúa y el problema considerado. Después se estudian los principales casos de uso del sistema y se relacionan con el framework propuesto. Más tarde, se proponen una serie de métodos de resolución eficientes para el problema analizado. Finalmente, se realiza una breve discusión sobre los principales resultados de implementación del sistema.This thesis focuses on the problem of task scheduling. Although slightly different definitions of task scheduling can be found in the literature, here it is defined as the allocation of a number of tasks - single actions that must be performed to complete a specific process-, to a set of resources, at specific moments in time. Examples of task scheduling can be found in many settings, as for example, the order in which the different parts of a car have to be manufactured in a set of machines, the allocation of operating rooms and surgeons to the surgical interventions in a hospital, or the order in which the customers of a restaurant should be served. Clearly, task scheduling is a core activity of many companies, both in manufacturing and in services, as it is essential for the coordination of the work between the different involved actors, such as departments, resources (human and physical) or external entities. In most settings, task scheduling involves treating large amounts of data related to the process and properly handling the set of constraints controlling this process. As a consequence, task scheduling is usually carried out with the help of computer tools that offer some type of support to the decision maker. In this regard, the rising of Information Technologies (ITs) in the last decades has helped enormously to develop computer systems providing support for decision making - i.e. Decision Support Systems (DSSs) - for many decisions, including task scheduling. At the same time, there has been a notable increase in computer capacity that has made possible facing task scheduling problems that were considered unsolvable some years ago. Despite these advances, an important gap between theory and practice has been found when translating these new conditions into practice, as it can be proven by the relatively short number of documented systems that have been correctly implemented and accepted by users. The working hypothesis in this Thesis is that, in order to reduce this gap between theory and practice, these tools should consider a number of aspects that have been studied in the literature but that have not been taken into account in practice during the implementation process, such as the role of the decision makers in these tools, the organisational context where scheduling decisions take place or the consideration of scheduling as a dynamic process. Typically, each time a company requires to implement of a DSS for task scheduling, in the following DSSTS, it faces two different options: either acquiring an off-the-shelf solution, or designing and developing an in-house tool. If the former option is chosen, the acquired solution may not fit perfectly into the activities of the company, and, since task scheduling is company-specific, this approach may result in a situation widely documented in the literature where there exist limited implementations that needs information systems working in parallel to deal with the specificities of the company. On the contrary, the second option usually derives in large implementation times with poor results, as the development team may not take into account errors or successes from former implementations, such as the functionalities that the system should include or the profiles required for the decision makers among others. As a summary, the design and implementation of DSSTS suffer a number of problems which constitute a root cause for the existing gap between the scheduling theory and its implementation into practice. In order to improve the activity of designing and developing DSSTS, the aim of this thesis is to propose a common framework for the development of DSSTS. In order to ensure the validity and range of application of this framework, its feasibility is analysed within two specific fields of applications, namely manufacturing and healthcare, and two implementation case studies are conducted within these fields. In order to fullfil this general objective, a number of specific objectives can be detailed: 1. To propose a framework for the design and development of DSSTS. • This framework address all the issues found in literature regarding the common failures when implementing this type of systems. A number of perspectives of the framework are given in order to properly detail it. 2. To analyse existing implementations of DSSTS in order to check the alignment of the framework proposed with the task scheduling systems implemented in the two sectors chosen for the evaluation of the framework. • A systematic literature review on manufacturing DSSTS is carried out. The reviewed contributions are classified according to their functionalities. A number of findings and conclusions about these findings are discussed. Additionally, a review on commercial operating room DSSTS is done. These contributions are also classified according to their functionality and a number of findings and conclusions about these findings are discussed. 3. To conduct the design and implementation of two DSSTS according to the proposed framework in order to demonstrate its applicability. • Based on the proposed framework, a manufacturing DSSTS and an operating room DSSTS are implemented: i. The manufacturing DSSTS is applied to a real manufacturing company in Sevilla. First, we describe the context where the DSSTS is deployed and the problem addressed, i.e. the hybrid flowshop scheduling problem with missing operations. Then, the main use cases of the DSSTS are discussed and related to the framework. Next, a set of efficient solution procedures for the problem under study are proposed. And finally, a brief discussion on the main results of the implementation of the DSSTS is carried out. ii. The operating room DSSTS is applied to a real hospital in Sevilla. First, we describe the context where the DSSTS is deployed and the problem addressed, i.e. the the operating room scheduling problem. Then, the main use cases of the DSSTS are discussed and related to the framework. Next, a set of efficient solution procedures for the problem under study are proposed. And finally, a brief discussion on the main results of the implementation of the DSSTS is carried out

The beginning of a new era in bone surgery Effectiveness and clinical application of a cold-ablation and robot-guided laser osteotome

Most industrial laser applications utilize computer and robot assistance, for guidance, safety, repeatability, and precision. For industrial applications, the increase in throughput and the processing speed are in the foreground. Nevertheless, these tools cannot just be transferred into clinical and surgical use because the focus in surgical interventions is on the exact implementation of a unique plan. The patient, as an inaccurately defined workpiece, with its individual anatomy and pathology, ultimately needs a single lot planning. Nowadays, medical laser systems are hand driven. The possibility of working precision, as used in industry lasers, is not exhausted. Therefore, medical laser beams have to be coupled to robot guidance. But due to the over-size of commercially available tools, efficient and ergonomic work in an operating room is impossible. Integration of the systems such as the laser source, and the robot arm are needed. Another key issue for the accuracy of the robotic arm is the inclusion of a tracking system. All these issues were encountered developing CARLO®: a Cold-Ablation and Robot-guided Laser Osteotome. This PhD thesis is divided in three parts: - an in-vivo study in sheep, - an in-vitro / wetlab study on human cadavers, and - a theoretical-experimental study to evaluate biomechanical changes in different osteotomy pattern. To test the applicability of the system in an operation theatre similar environment, an in-vivo animal trial was performed. Additionally, we wanted to demonstrate that bone healing after laser osteotomy is not impaired compared to the standard tool the piezo-osteotome. In terms of new mineralized bone formation, histological and micro-CT analysis showed clearly a higher tendency towards the acceleration of the healing process in the laser group. Additionally, no signs of bone necrosis were seen. In addition to the pure functioning of the device, the applicability in the clinic is important for technology to prevail. Therefore, dummy tests for the ergonomics and cadaver tests for the simulation of "real" operations in the cranio-maxillofacial field were performed. Wetlab tests were conducted on human cadavers where different macro-retentive osteotomy patterns were performed. It could be demonstrated that our prototype shows advantages over the current state of the art cutting tools, e.g. reduced bone loss, precise and real-time navigated execution of predefined geometries of freely selected osteotomy patterns. This advantage can be implemented in another indication of our prototype in the cranio-maxillofacial field: in craniosynostosis surgery. We performed a study using finite element analysis to simulate incomplete osteotomies on the inner side of the bone flap to facilitate the re-shaping (skull molding). This biomechanical analysis intended to create basic knowledge in terms of the best stress vs. force relation to obtain the largest projected bone surface. Moreover, a human multicenter study is ready to start for the clinical introduction of the cold-ablation and robot-guided laser osteotome and to gain more experience and information for future work

Optical techniques for 3D surface reconstruction in computer-assisted laparoscopic surgery

One of the main challenges for computer-assisted surgery (CAS) is to determine the intra-opera- tive morphology and motion of soft-tissues. This information is prerequisite to the registration of multi-modal patient-specific data for enhancing the surgeon’s navigation capabilites by observ- ing beyond exposed tissue surfaces and for providing intelligent control of robotic-assisted in- struments. In minimally invasive surgery (MIS), optical techniques are an increasingly attractive approach for in vivo 3D reconstruction of the soft-tissue surface geometry. This paper reviews the state-of-the-art methods for optical intra-operative 3D reconstruction in laparoscopic surgery and discusses the technical challenges and future perspectives towards clinical translation. With the recent paradigm shift of surgical practice towards MIS and new developments in 3D opti- cal imaging, this is a timely discussion about technologies that could facilitate complex CAS procedures in dynamic and deformable anatomical regions

Robot Assisted Laser Osteotomy

In the scope of this thesis world\u27s first robot system was developed, which facilitates osteotomy using laser in arbitrary geometries with an overall accuracy below 0.5mm. Methods of computer and robot assisted surgery were reconsidered and composed to a workflow. Adequate calibration and registration methods are proposed. Further a methodology for transferring geometrically defined cutting trajectories into pulse sequences and optimized execution plans is developed

Catalan Health Institute: 2012 Annual Report

Sistema sanitari públic; Activitat assistencial; MemòriaPublic health system; Healthcare activity; ReportSistema sanitario público; Actividad asistencial; MemoriaLa Memòria de l’Institut Català de la Salut vol ser un reflex de la realitat de l’empresa sanitària més gran del país. En aquest document trobareu un recull de la feina realitzada pels professionals de la institució, que s’orienta a millorar la salut de la ciutadania