System for surgical block schedule optimization

Proper distribution and utilization of operating rooms is one of the biggest factors when combating the ever growing waiting lists for surgical interventions. In this ecosystem, the incorrect prediction of a procedure’s duration will imply the remaining scheduled procedures, further more when this prediction is an underestimation. This problem is is exacerbated by the sheer amount of different interventions with their specificities and conditions. Tackling this question, we developed an application running along side the main surgery schedule of Centro Hospitalar de São João, in charge of applying regression algorithms to better calculate the expected surgery duration. With these, we were able to apply a scheduling algorithm that produces a viable surgery table. Our final implementation was able to work independently of human interaction, producing a possible alternative to the manual methods common on these situations.A distribuição e utilização adequada dos blocos operatórios é um dos principais fatores quando se visa diminuir o constante aumento das listas de espera para intervenções cirúrgicas. Neste ecossistema, uma má previsão da duração de um procedimento trará problemas na restante calendarização dos procedimentos, ainda mais quando esta previsão é menor que o tempo real de cirurgia. A resolução deste problema é exacerbada pela quantidade de diferentes intervenções, com as suas especificidades e condições. Para fazer face a esta questão, desenvolvemos uma aplicação que corre ao lado do calendário principal do Centro Hospitalar de São João, encarregado de aplicar algoritmos de regressão para melhorar o calculo da duração da cirurgia. A nossa implementação final foi capaz de trabalhar independentemente da interação humana, produzindo uma alternativa apossável aos métodos manuais comuns nestas situações

Prioritization of patients' access to health care services

L'accès aux services de santé et les longs délais d'attente sont l’un des principaux problèmes dans la plupart des pays du monde, dont le Canada et les États-Unis. Les organismes de soins de santé ne peuvent pas augmenter leurs ressources limitées, ni traiter tous les patients simultanément. C'est pourquoi une attention particulière doit être portée à la priorisation d'accès des patients aux services, afin d’optimiser l’utilisation de ces ressources limitées et d’assurer la sécurité des patients. En fait, la priorisation des patients est une pratique essentielle, mais oubliée dans les systèmes de soins de santé à l'échelle internationale. Les principales problématiques que l’on retrouve dans la priorisation des patients sont: la prise en considération de plusieurs critères conflictuels, les données incomplètes et imprécises, les risques associés qui peuvent menacer la vie des patients durant leur mise sur les listes d'attente, les incertitudes présentes dans les décisions des cliniciens et patients, impliquant l'opinion des groupes de décideurs, et le comportement dynamique du système. La priorisation inappropriée des patients en attente de traitement a une incidence directe sur l’inefficacité des prestations de soins de santé, la qualité des soins, et surtout sur la sécurité des patients et leur satisfaction. Inspirés par ces faits, dans cette thèse, nous proposons de nouveaux cadres hybrides pour prioriser les patients en abordant un certain nombre de principales lacunes aux méthodes proposées et utilisées dans la littérature et dans la pratique. Plus précisément, nous considérons tout d'abord la prise de décision collective incluant les multiples critères de priorité, le degré d'importance de chacun de ces critères et de leurs interdépendances dans la procédure d'établissement des priorités pour la priorisation des patients. Puis, nous travaillons sur l'implication des risques associés et des incertitudes présentes dans la procédure de priorisation, dans le but d'améliorer la sécurité des patients. Enfin, nous présentons un cadre global en se concentrant sur tous les aspects mentionnés précédemment, ainsi que l'implication des patients dans la priorisation, et la considération des aspects dynamiques du système dans la priorisation. À travers l'application du cadre global proposé dans le service de chirurgie orthopédique à l'hôpital universitaire de Shohada, et dans un programme clinique de communication augmentative et alternative appelé PACEC à l'Institut de réadaptation en déficience physique de Québec (IRDPQ), nous montrons l'efficacité de nos approches en les comparant avec celles actuellement utilisées. Les résultats prouvent que ce cadre peut être adopté facilement et efficacement dans différents organismes de santé. Notamment, les cliniciens qui ont participé à l'étude ont conclu que le cadre produit une priorisation précise et fiable qui est plus efficace que la méthode de priorisation actuellement utilisée. En résumé, les résultats de cette thèse pourraient être bénéfiques pour les professionnels de la santé afin de les aider à: i) évaluer la priorité des patients plus facilement et précisément, ii) déterminer les politiques et les lignes directrices pour la priorisation et planification des patients, iii) gérer les listes d'attente plus adéquatement, vi) diminuer le temps nécessaire pour la priorisation des patients, v) accroître l'équité et la justice entre les patients, vi) diminuer les risques associés à l’attente sur les listes pour les patients, vii) envisager l'opinion de groupe de décideurs dans la procédure de priorisation pour éviter les biais possibles dans la prise de décision, viii) impliquer les patients et leurs familles dans la procédure de priorisation, ix) gérer les incertitudes présentes dans la procédure de prise de décision, et finalement x) améliorer la qualité des soins.Access to health care services and long waiting times are one of the main issues in most of the countries including Canada and the United States. Health care organizations cannot increase their limited resources nor treat all patients simultaneously. Then, patients’ access to these services should be prioritized in a way that best uses the scarce resources, and to ensure patients’ safety. In fact, patients’ prioritization is an essential but forgotten practice in health care systems internationally. Some challenging aspects in patients’ prioritization problem are: considering multiple conflicting criteria, incomplete and imprecise data, associated risks that threaten patients on waiting lists, uncertainties in clinicians’ decisions, involving a group of decision makers’ opinions, and health system’s dynamic behavior. Inappropriate prioritization of patients waiting for treatment, affects directly on inefficiencies in health care delivery, quality of care, and most importantly on patients’ safety and their satisfaction. Inspired by these facts, in this thesis, we propose novel hybrid frameworks to prioritize patients by addressing a number of main shortcomings of current prioritization methods in the literature and in practice. Specifically, we first consider group decision-making, multiple prioritization criteria, these criteria’s importance weights and their interdependencies in the patients’ prioritization procedure. Then, we work on involving associated risks that threaten patients on waiting lists and handling existing uncertainties in the prioritization procedure with the aim of improving patients’ safety. Finally, we introduce a comprehensive framework focusing on all previously mentioned aspects plus involving patients in the prioritization, and considering dynamic aspects of the system in the patients’ prioritization. Through the application of the proposed comprehensive framework in the orthopedic surgery ward at Shohada University Hospital, and in an augmentative and alternative communication (AAC) clinical program called PACEC at the Institute for Disability Rehabilitation in Physics of Québec (IRDPQ), we show the effectiveness of our approaches comparing the currently used ones. The implementation results prove that this framework could be adopted easily and effectively in different health care organizations. Notably, clinicians that participated in the study concluded that the framework produces a precise and reliable prioritization that is more effective than the currently in use prioritization methods. In brief, the results of this thesis could be beneficial for health care professionals to: i) evaluate patients’ priority more accurately and easily, ii) determine policies and guidelines for patients’ prioritization and scheduling, iii) manage waiting lists properly, vi) decrease the time required for patients’ prioritization, v) increase equity and justice among patients, vi) diminish risks that could threaten patients during waiting time, vii) consider all of the decision makers’ opinions in the prioritization procedure to prevent possible biases in the decision-making procedure, viii) involve patients and their families in the prioritization procedure, ix) handle available uncertainties in the decision-making procedure, and x) increase quality of care

Modelling activity times by hybrid synthetic method

Uncertain (manual) activity times impact a number of manufacturing system modules: plant and layout design, capacity analysis, operator assignment, process planning, scheduling and simulation. Direct observation cannot be used for non-existent production lines. A hybrid direct observation/synthetic method derived from Method Time Measurement available in industry is proposed. To determine accurate activity times required by heuristics and metaheuristics optimisation, manufacturing system modules are modelled by MILP and operator efficiency parameters are used for time standardisation. Among human factors considered are skill and ergonomics. Application to the sterilisation of reusable medical devices is extensively described. Experimental data taken from observation on the field and a worst-case date have shown the model direct applicability for professionals also to non-manufacturing cases

COMPREHENSIVE FRAMEWORKS FOR DECISION MAKING SUPPORT IN MEDICAL EQUIPMENT MANAGEMENT

Throughout medical equipment life cycle, hospitals need to take decisions on medical equipment management based upon a set of different criteria. In fact, medical equipment acquisition, preventive maintenance, and replacement are considered the most important phases, accordingly a properly planned management for these issues is considered a key decision of medical equipment management. In this thesis, a set of frameworks were developed regarding acquisition, preventive maintenance, and replacement to improve management process of medical equipment. In practice, quality function deployment was proposed as a core method around which the frameworks were developed

Operating rooms scheduling for elective surgeries in a hospital affected by war-related incidents

Hospital scheduling presents huge challenges for the healthcare industry. Various studies have been conducted in many different countries with focus on both elective and non-elective surgeries. There are important variables and factors that need to be taken into considerations. Different methods and approaches have also been used to examine hospital scheduling. Notwithstanding the continuous changes in modern healthcare services and, in particular, hospital operations, consistent reviews and further studies are still required. The importance of hospital scheduling, particularly, has become more critical as the trade-off between limited resources and overwhelming demand is becoming more evident. This situation is even more pressing in a volatile country where shootings and bombings in public areas happened. Hospital scheduling for elective surgeries in volatile country such as Iraq is therefore often interrupted by non-elective surgeries due to war-related incidents. Hence, this paper intends to address this issue by proposing a hospital scheduling model with focus on neuro-surgery department. The aim of the model is to maximize utilization of operating room while concurrently minimizing idle time of surgery. The study focused on neurosurgery department in Al-Shahid Ghazi Al-Hariri hospital in Baghdad, Iraq. In doing so, a Mixed-integer linear programming (MILP) model is formulated where interruptions of non-elective surgery are incorporated into the main elective surgery based model. Computational experiment is then carried out to test the model. The result indicates that the model is feasible and can be solved in reasonable times. Nonetheless, its feasibility is further tested as the problems size and the computation times is getting bigger and longer. Application of heuristic methods is the way forward to ensure better practicality of the proposed model. In the end, the potential benefit of this study and the proposed model is discussed

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

Cost Factor Focused Scheduling and Sequencing: A Neoteric Literature Review

The hastily emergent concern from researchers in the application of scheduling and sequencing has urged the necessity for analysis of the latest research growth to construct a new outline. This paper focuses on the literature on cost minimization as a primary aim in scheduling problems represented with less significance as a whole in the past literature reviews. The purpose of this paper is to have an intensive study to clarify the development of cost-based scheduling and sequencing (CSS) by reviewing the work published over several parameters for improving the understanding in this field. Various parameters, such as scheduling models, algorithms, industries, journals, publishers, publication year, authors, countries, constraints, objectives, uncertainties, computational time, and programming languages and optimization software packages are considered. In this research, the literature review of CSS is done for thirteen years (2010-2022). Although CSS research originated in manufacturing, it has been observed that CSS research publications also addressed case studies based on health, transportation, railway, airport, steel, textile, education, ship, petrochemical, inspection, and construction projects. A detailed evaluation of the literature is followed by significant information found in the study, literature analysis, gaps identification, constraints of work done, and opportunities in future research for the researchers and experts from the industries in CSS