The Impact of Block Scheduling and Release Time on Operating Room Efficiency

Planning for sufficient surgical capacity at a hospital requires that many tactical and operational decisions be made before the day of surgery. Typically, blocks of time in operating rooms (ORs) are assigned and specific surgical cases are placed in rooms. The hospital monitors utilization to determine the schedule\u27s effectiveness in balancing the risk of overtime with idle time. In this thesis, we will examine how adjusting schedule risk ratios and penalty values, and providing shared, open posting time affected the hospital\u27s ability to identify an efficient but high quality and low cost block schedule. The proposed schedules were tested by assigning surgical cases to ORs and simulating the schedule\u27s performance using recent data from a local hospital. We also show how scheduling accuracy can impact the performance level of the schedules proposed. Once the schedule has been set, the use of block release time is investigated in order to provide insight on how to better fill these ORs and increase utilization levels. Release policies are simulated based on various surgery arrival distributions, capacity levels, and case durations. We will show how different policies involving assigned and open posting rooms impact utilization levels, number of cases not fit into the schedule, and number of cases posted after the block release time

Joint optimization of allocation and release policy decisions for surgical block time under uncertainty

The research presented in this dissertation contributes to the growing literature on applications of operations research methodology to healthcare problems through the development and analysis of mathematical models and simulation techniques to find practical solutions to fundamental problems facing nearly all hospitals. In practice, surgical block schedule allocation is usually determined regardless of the stochastic nature of case demand and duration. Once allocated, associated block time release policies, if utilized, are often simple rules that may be far from optimal. Although previous research has examined these decisions individually, our model considers them jointly. A multi-objective model that characterizes financial, temporal, and clinical measures is utilized within a simulation optimization framework. The model is also used to test “conventional wisdom” solutions and to identify improved practical approaches. Our result from scheduling multi-priority patients at the Stafford hospital highlights the importance of considering the joint optimization of block schedule and block release policy on quality of care and revenue, taking into account current resources and performance. The proposed model suggests a new approach for hospitals and OR managers to investigate the dynamic interaction of these decisions and to evaluate the impact of changes in the surgical schedule on operating room usage and patient waiting time, where patients have different sensitivities to waiting time. This study also investigated the performance of multiple scheduling policies under multi-priority patients. Experiments were conducted to assess their impacts on the waiting time of patients and hospital profit. Our results confirmed that our proposed threshold-based reserve policy has superior performance over common scheduling policies by preserving a specific amount of OR time for late-arriving, high priority demand

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;

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

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

Intestinal tuberculosis

Purpose of reviewIntestinal tuberculosis (TB) is increasing due partly to the HIV pandemic. Its clinical presentation mimics inflammatory conditions such as Crohn's disease and malignancies, which are becoming more prevalent, so the diagnosis is problematic.Recent findingsGreater awareness of intestinal TB is needed, both in countries where TB is endemic and developed countries with immigrant populations. Some strains of Mycobacterium tuberculosis are associated with more extrapulmonary disease and greater dissemination, thereby exacerbating the rise in HIV-associated extrathoracic TB. Recent retrospective and prospective studies are leading to the development of diagnostic algorithms. A wide range of imaging techniques is available for sampling and diagnosis. New biochemical, immunological and molecular diagnostic methods are being developed but must be standardized and validated. Developments in drug delivery will facilitate oral therapy even in patients suffering from malabsorption.SummaryThere is an increasing consensus on the risk factors and clinical presentations of intestinal TB. Imaging techniques, coupled with fine needle biopsies, are useful aids to diagnosis, but most important is a greater awareness of the condition by clinicians

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

Health Care Benefits -- Creating the Optimal Design

Explores the role of benefit design and market innovations such as consumer-driven health plans and value-based insurance design to maximize beneficial coverage and offer incentives for better health and efficiency. Outlines implications for reform

Secure and Trustable Electronic Medical Records Sharing using Blockchain

Electronic medical records (EMRs) are critical, highly sensitive private information in healthcare, and need to be frequently shared among peers. Blockchain provides a shared, immutable and transparent history of all the transactions to build applications with trust, accountability and transparency. This provides a unique opportunity to develop a secure and trustable EMR data management and sharing system using blockchain. In this paper, we present our perspectives on blockchain based healthcare data management, in particular, for EMR data sharing between healthcare providers and for research studies. We propose a framework on managing and sharing EMR data for cancer patient care. In collaboration with Stony Brook University Hospital, we implemented our framework in a prototype that ensures privacy, security, availability, and fine-grained access control over EMR data. The proposed work can significantly reduce the turnaround time for EMR sharing, improve decision making for medical care, and reduce the overall costComment: AMIA 2017 Annual Symposium Proceeding

Lessons From India in Organizational Innovation: A Tale of Two Heart Hospitals

Recent discussions in health reform circles have pinned great hopes on the prospect of innovation as the solution to the high-cost, inadequate-quality U.S. health system. But U.S. health care institutions--insurers, providers and specialists--have ceded leadership in innovation to Indian hospitals such as Care Hospital in Hyderabad and the Fortis Hospitals around New Delhi, which have U.S.-trained doctors and can perform open heart surgery for $6000 (compared to$100,000 in the United States). The Indian success is a window into America\u27s stalemate with inflating costs and stagnant innovation

Consultancy to progress hospital in the home care provision: Final report, CHERE Project Report No 13

In July 1998, the Commonwealth Department of Health and Family Services commissioned the Centre for Health Economics Research and Evaluation (CHERE) to identify and document Hospital in the Home (HITH) care models nationally and internationally. The purpose of this consultancy was to examine the appropriateness of this form of care for acutely ill patients and to make recommendations about how to increase the utilisation and cost effectiveness of services. Hospital in the Home is emerging internationally and within Australia as a viable alternative form of provision of acute care. The benefits of HITH have generally been seen in terms of its capacity to provide a cost-effective and acceptable alternative to hospital inpatient care, which reduces pressure on hospital beds. However, so far there has only been limited evaluation to lend support to these claims. Over the past decade a wide range of hospital in the home programs have been introduced across the Australian health care system. These programs have often emerged in response to local factors and have a range of different purposes, funding and organisational arrangements, and varying levels of success. In some states hospital in the home has been formalised into a program, whereas in other parts of Australia the introduction of HITH has been left to local decision makers. Thus, the experience of HITH has been extremely variable. It is appropriate at this stage to draw together information about what services are available, how acceptable these services are and what they have achieved. This information is important for determining the future directions of HITH in Australia, as well as providing a valuable resource for service providers and policy makers.Hospital in the home, Australia