2,320 research outputs found

    Operating room planning and scheduling: A literature review.

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    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;

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

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    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

    Operational and strategic decision making in the perioperative setting: Meeting budgetary challenges and quality of care goals.

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    Efficient operating room (OR) management is a constant balancing act between optimal OR capacity, allocation of ORs to surgeons, assignment of staff, ordering of materials, and reliable scheduling, while according the highest priority to patient safety. We provide an overview of common concepts in OR management, specifically addressing the areas of strategic, tactical, and operational decision making (DM), and parameters to measure OR efficiency. For optimal OR productivity, a surgical suite needs to define its main stakeholders, identify and create strategies to meet their needs, and ensure staff and patient satisfaction. OR planning should be based on real-life data at every stage and should apply newly developed algorithms

    Operating Room Scheduling in Teaching Hospitals

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    Operating room scheduling is an important operational problem in most hospitals. In this paper, a novel mixed integer programming (MIP) model is presented for minimizing Cmax and operating room idle times in hospitals. Using this model, we can determine the allocation of resources including operating rooms, surgeons, and assistant surgeons to surgeries, moreover the sequence of surgeries within operating rooms and the start time of them. The main features of the model will include the chronologic curriculum plan for training residents and the real-life constraints to be observed in teaching hospitals. The proposed model is evaluated against some real-life problems, by comparing the schedule obtained from the model and the one currently developed by the hospital staff. Numerical results indicate the efficiency of the proposed model compared to the real-life hospital scheduling, and the gap evaluations for the instances show that the results are generally satisfactory

    How to juggle priorities? An interactive tool to provide quantitative support for strategic patient-mix decisions: an ophthalmology case

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    An interactive tool was developed for the ophthalmology department of the Academic Medical Center to quantitatively support management with strategic patient-mix decisions. The tool enables management to alter the number of patients in various patient groups and to see the consequences in terms of key performance indicators. In our case study, we focused on the bottleneck: the operating room. First, we performed a literature review to identify all factors that influence an operating room's utilization rate. Next, we decided which factors were relevant to our study. For these relevant factors, two quantitative methods were applied to quantify the impact of an individual factor: regression analysis and computer simulation. Finally, the average duration of an operation, the number of cancellations due to overrun of previous surgeries, and the waiting time target for elective patients all turned out to have significant impact. Accordingly, for the case study, the interactive tool was shown to offer management quantitative decision support to act proactively to expected alterations in patient-mix. Hence, management can anticipate the future situation, and either alter the expected patient-mix or expand capacity to ensure that the key performance indicators will be met in the future

    Prioritization of patients' access to health care services

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    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

    Operating Room (Re)Scheduling with Bed Management via ASP

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    The Operating Room Scheduling (ORS) problem is the task of assigning patients to operating rooms (ORs), taking into account different specialties, lengths, and priority scores of each planned surgery, OR session durations, and the availability of beds for the entire length of stay (LOS) both in the Intensive Care Unit (ICU) and in the wards. A proper solution to the ORS problem is of primary importance for the healthcare service quality and the satisfaction of patients in hospital environments. In this paper we first present a solution to the problem based on Answer Set Programming (ASP). The solution is tested on benchmarks with realistic sizes and parameters, on three scenarios for the target length on 5-day scheduling, common in small-medium-sized hospitals, and results show that ASP is a suitable solving methodology for the ORS problem in such setting. Then, we also performed a scalability analysis on the schedule length up to 15 days, which still shows the suitability of our solution also on longer plan horizons. Moreover, we also present an ASP solution for the rescheduling problem, that is, when the offline schedule cannot be completed for some reason. Finally, we introduce a web framework for managing ORS problems via ASP that allows a user to insert the main parameters of the problem, solve a specific instance, and show results graphically in real time

    An integrated decision analytic framework of machine learning with multi-criteria decision making for patient prioritization in elective surgeries

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    Objectif: De nombreux centres de santé à travers le monde utilisent des critères d'évaluation des préférences cliniques (CPAC) pour donner la priorité aux patients pour accéder aux chirurgies électives. Le processus de priorisation clinique du patient utilise à cette fin les caractéristiques du patient et se compose généralement de critères cliniques, d'expériences de patients précédemment hospitalisés et de commentaires sur les réseaux sociaux. Le but de la hiérarchisation des patients est de déterminer un ordre précis pour les patients et de déterminer combien chaque patient bénéficiera de la chirurgie. En d'autres termes, la hiérarchisation des patients est un type de problème de prise de décision qui détermine l'ordre de ceux qui ont le plus bénéficié de la chirurgie. Cette étude vise à développer une méthodologie hybride en intégrant des algorithmes d'apprentissage automatique et des techniques de prise de décision multicritères (MCDM) afin de développer un nouveau modèle de priorisation des patients. L'hypothèse principale est de valider le fait que l'intégration d'algorithmes d'apprentissage automatique et d'outils MCDM est capable de mieux prioriser les patients en chirurgie élective et pourrait conduire à une plus grande précision. Méthode: Cette étude vise à développer une méthodologie hybride en intégrant des algorithmes d'apprentissage automatique et des techniques de prise de décision multicritères (MCDM) afin de développer un modèle précis de priorisation des patients. Dans un premier temps, une revue de la littérature sera effectuée dans différentes bases de données pour identifier les méthodes récemment développées ainsi que les facteurs de risque / attributs les plus courants dans la hiérarchisation des patients. Ensuite, en utilisant différentes méthodes MCDM telles que la pondération additive simple (SAW), le processus de hiérarchie analytique (AHP) et VIKOR, l'étiquette appropriée pour chaque patient sera déterminée. Dans la troisième étape, plusieurs algorithmes d'apprentissage automatique seront appliqués pour deux raisons: d'abord la sélection des caractéristiques parmi les caractéristiques communes identifiées dans la littérature et ensuite pour prédire les classes de patients initialement déterminés. Enfin, les mesures détaillées des performances de prédiction des algorithmes pour chaque méthode seront déterminées. Résultats: Les résultats montrent que l'approche proposée a atteint une précision de priorisation assez élevée(~70 %). Cette précision a été obtenue sur la base des données de 300 patients et elle pourrait être considérablement améliorée si nous avions accès à plus de données réelles à l'avenir. À notre connaissance, cette étude présente la première et la plus importante du genre à combiner efficacement les méthodes MCDM avec des algorithmes d'apprentissage automatique dans le problème de priorisation des patients en chirurgie élective.Objective: Many healthcare centers worldwide use Clinical Preference Assessment criteria (CPAC) to prioritize patients for accessing elective surgeries [44]. The patient's clinical prioritization process uses patient characteristics for this purpose and usually consists of clinical criteria, experiences of patients who have been previously hospitalized, and comments on social media. The sense of patient prioritization is to determine an accurate ordering for patients and how much each patient will benefit from the surgery. This research intends to build a hybrid approach for creating a new patient prioritizing model by combining machine learning algorithms with multi-criteria decision-making (MCDM) methodologies. The central hypothesis is to validate that the integration of machine learning algorithms and MCDM tools can better prioritize elective surgery patients and lead to higher accuracy. Method: As a first step, a literature review was performed in different databases to identify the recently developed methods and the most common criteria in patient prioritization. Then, using various MCDM methods, including simple additive weighting (SAW), analytical hierarchy process (AHP), and VIKOR, the appropriate label for each patient was determined. As the third step, several machine learning algorithms were applied to predict each patient's classes. Finally, we established the algorithms' precise prediction performance metrics for each approach. Results: The results show that the proposed approach has achieved relatively high prioritization accuracy (~70%). This accuracy has been obtained based on the data from 300 patients, and it could be significantly improved if we have access to more accurate data in the future. To the best of our knowledge, this research is the first of its type to demonstrate the effectiveness of combining MCDM methodologies with machine learning algorithms in patient prioritization problems in elective surgery

    Prioritizing Patients: Stochastic Dynamic Programming for Surgery Scheduling and Mass Casualty Incident Triage

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    The research presented in this dissertation contributes to the growing literature on applications of operations research models to problems in healthcare through the development and analysis of mathematical models for two fundamental problems facing nearly all hospitals: the single-day surgery scheduling problem and planning for triage in the event of a mass casualty incident. Both of these problems can be understood as sequential decision-making processes aimed at prioritizing between different classes of patients under significant uncertainty and are modeled using stochastic dynamic programming. Our study of the single-day surgery scheduling problem represents the first model to capture the sequential nature of the operating room (OR) manager's decisions during the transition between the generality of cyclical block schedules (which allocate OR time to surgical specialties) and the specificity of schedules for a particular day (which assign individual patients to specific ORs). A case study of the scheduling system at the University of Maryland Medical Center highlights the importance of the decision to release unused blocks of OR time and use them to schedule cases from the surgical request queue (RQ). Our results indicate that high quality block release and RQ decisions can be made using threshold-based policies that preserve a specific amount of OR time for late-arriving demand from the specialties on the block schedule. The development of mass casualty incident (MCI) response plans has become a priority for hospitals, and especially emergency departments and trauma centers, in recent years. Central to all MCI response plans is the triage process, which sorts casualties into different categories in order to facilitate the identification and prioritization of those who should receive immediate treatment. Our research relates MCI triage to the problem of scheduling impatient jobs in a clearing system and extends earlier research by incorporating the important trauma principle that patients' long-term (post-treatment) survival probabilities deteriorate the longer they wait for treatment. Our results indicate that the consideration of deteriorating survival probabilities during MCI triage decisions, in addition to previously studied patient characteristics and overall patient volume, increases the total number of expected survivors
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