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

Outlier admissions of medical patients: Prognostic implications of outlying patients. The experience of the Hospital of Mestre

ABSTRACT The admission of a patient in wards other than the appropriate ones, known as the patient outlying phenomenon, involves both Medicine and Geriatric Units of many Hospitals. The aims were to learn more about the prognosis of the outlying patients, we investigated 3828 consecutive patients hospitalized in Medicine and Geriatrics of our hub Hospital during the year 2012. We compared patients\u2019 mean hospital length of stay, survival, and early readmission according to their outlying status. The mean hospital length of stay did not significantly differ between the two groups, either for Medicine (9.8 days for outliers and 10.0 for in-ward) or Geriatrics (13.0 days for both). However, after adjustment for age and sex, the risk of death was about twice as high for outlier patients admitted into surgical compared to medical areas (hazard ratio 1.8, 1.2-2.5 95% confidence interval). Readmission within 90 days from the first discharge was more frequent for patients admitted as outliers (26.1% vs 14.2%, P<0.0001). We highlight some critical aspects of an overcrowded hospital, as the shortage of beds in Medicine and Geriatrics and the potential increased clinical risk denoted by deaths or early readmission for medical outlier patients when assigned to inappropriate wards. There is the need to reorganize beds allocation involving community services, improve in-hospital bed management, an extent diagnostic procedures for outlier patients admitted in nonmedical wards

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;

Evaluating the capacity of clinical pathways through discrete-event simulation.

Organizing a medical facility efficiently is hard due to the numerous patient trajectories and their use of joint and scarce resources. Moreover, these trajectories tend to be complex and characterized by uncertain medical processes. In this paper, we will structure patient trajectories using clinical pathways and aggregate them in a discrete-event simulation model. This model enables the health manager to evaluate and improve important performance indicators, both for the patient and the hospital, by conducting a detailed sensitivity analysis. Two case studies, performed at large hospitals in Antwerp and Leuven (Belgium), will be introduced and briefly discussed in order to illustrate the generic nature of the model.Capacity management; Case studies; Discrete-event simulation; Health care operations; Processes; Structure; Simulation; Model; Performance; Indicators; Sensitivity; Studies; Hospitals; Belgium; Order;

A discrete event simulation model to support bed management

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this record.In recent years, due to the overcrowding of Emergency Department (ED) and the growing concern in reducing the number of inpatient ward beds, it has become crucial to improve the capacity planning and control activities, which manage the patient flows from EDs to hospital wards. Bed Management has a key role in this context. This study starts by a collaboration with the Local Health Government (LHG) of the Liguria region aimed at studying the impact of supporting bed management with some operational strategies without increasing the bed capacity. A large amount of data was collected over a one-year period at public hospital in Genova and a preliminary observational analysis was conducted to get the main information about the flow of emergency and elective patients from ED to inpatient wards. A Discrete Event Simulation (DES) model has been then developed in order to represent the real system. A scenarios analysis is proposed to assess the best strategy to improve the system performance without increasing bed capacity, by simply synchronizing bed supply and demand. The model can be used as a decision support tool to optimise the use of the available resources as well as to improve the quality of the patient pathway inside the hospital.The authors acknowledge support from the Italian Ministry of Education, University and Research (MIUR), under the grand FIRB n. RBFR081KSB. Data have been made available thanks to a collaboration between ARS Liguria (Dr. Francesco Quaglia and Domenico Gallo) and the Department of Economics and Business, University of Genova

Integrated Planning in Hospitals: A Review

Efficient planning of scarce resources in hospitals is a challenging task for which a large variety of Operations Research and Management Science approaches have been developed since the 1950s. While efficient planning of single resources such as operating rooms, beds, or specific types of staff can already lead to enormous efficiency gains, integrated planning of several resources has been shown to hold even greater potential, and a large number of integrated planning approaches have been presented in the literature over the past decades. This paper provides the first literature review that focuses specifically on the Operations Research and Management Science literature related to integrated planning of different resources in hospitals. We collect the relevant literature and analyze it regarding different aspects such as uncertainty modeling and the use of real-life data. Several cross comparisons reveal interesting insights concerning, e.g., relations between the modeling and solution methods used and the practical implementation of the approaches developed. Moreover, we provide a high-level taxonomy for classifying different resource-focused integration approaches and point out gaps in the literature as well as promising directions for future research