ADAPTIVE SCHEDULING FOR OPERATING ROOM MANAGEMENT

The perioperative process in hospitals can be modelled as a 3-stage no-wait flow shop. The utilization of OR units and the average waiting time of patients are related to makespan and total completion time, respectively. However, minimizations of makespan and total completion time are NP-hard and NP-complete. Consequently, achieving good effectiveness and efficiency is a challenge in no-wait flow shop scheduling. The average idle time (AIT) and current and future idle time (CFI) heuristics are proposed to minimize makespan and total completion time, respectively. To improve effectiveness, current idle times and future idle times are taken into consideration and the insertion and neighborhood exchanging techniques are used. To improve efficiency, an objective increment method is introduced and the number of iterations is determined to reduce the computation times. Compared with three best-known heuristics for each objective, AIT and CFI heuristics can achieve greater effectiveness in the same computational complexity based on a variety of benchmarks. Furthermore, AIT and CFI heuristics perform better on trade-off balancing compared with other two best-known heuristics. Moreover, using the CFI heuristic for operating room (OR) scheduling, the average patient flow times are decreased by 11.2% over historical ones at University of Kentucky Health Care

Enhanced photochemical hydrogen production by a molecular diiron catalyst incorporated into a metal-organic framework.

A molecular proton reduction catalyst [FeFe](dcbdt)(CO)6 (1, dcbdt = 1,4-dicarboxylbenzene-2,3-dithiolate) with structural similarities to [FeFe]-hydrogenase active sites has been incorporated into a highly robust Zr(IV)-based metal-organic framework (MOF) by postsynthetic exchange (PSE). The PSE protocol is crucial as direct solvothermal synthesis fails to produce the functionalized MOF. The molecular integrity of the organometallic site within the MOF is demonstrated by a variety of techniques, including X-ray absorption spectroscopy. In conjunction with [Ru(bpy)3](2+) as a photosensitizer and ascorbate as an electron donor, MOF-[FeFe](dcbdt)(CO)6 catalyzes photochemical hydrogen evolution in water at pH 5. The immobilized catalyst shows substantially improved initial rates and overall hydrogen production when compared to a reference system of complex 1 in solution. Improved catalytic performance is ascribed to structural stabilization of the complex when incorporated in the MOF as well as the protection of reduced catalysts 1(-) and 1(2-) from undesirable charge recombination with oxidized ascorbate

An Optimization Model for Operating Room Scheduling to Reduce Blocking Across the Perioperative Process

Operating room (OR) scheduling is important. Because of increasing demand for surgical services, hospitals must provide high quality care more efficiently with limited resources. When constructing the OR schedule, it is necessary to consider the availability of downstream resources, such as intensive care unit (ICU) and post anaesthesia care unit (PACU). The unavailability of downstream resources causes blockings between every two consecutive stages. In this paper we address the master surgical schedule (MSS) problem in order to minimize blockings between two consecutive stages. First, we present a blocking minimization (BM) model for the MSS by using integer programming, based on deterministic data. The BM model determines the OR block schedule for the next day by considering the current stage occupancy (number of patients) in order to minimize the number of blockings between intraop and postop stages. Second, we test the effectiveness of our model under variations in case times and patient arrivals, by using simulation. The simulation results show that our BM model can significantly reduce the number of blockings by 94% improvement over the base model. Scheduling patient flow across the 3-stage periop process can be applied to work flow scheduling for the s-stage flow shop shop production in manufacutirng, and also Smoothing patient flow in periop process can be applied to no-wait flow shop production

Modeling Rare Interactions in Time Series Data Through Qualitative Change: Application to Outcome Prediction in Intensive Care Units

Many areas of research are characterised by the deluge of large-scale highly-dimensional time-series data. However, using the data available for prediction and decision making is hampered by the current lag in our ability to uncover and quantify true interactions that explain the outcomes.We are interested in areas such as intensive care medicine, which are characterised by i) continuous monitoring of multivariate variables and non-uniform sampling of data streams, ii) the outcomes are generally governed by interactions between a small set of rare events, iii) these interactions are not necessarily definable by specific values (or value ranges) of a given group of variables, but rather, by the deviations of these values from the normal state recorded over time, iv) the need to explain the predictions made by the model. Here, while numerous data mining models have been formulated for outcome prediction, they are unable to explain their predictions. We present a model for uncovering interactions with the highest likelihood of generating the outcomes seen from highly-dimensional time series data. Interactions among variables are represented by a relational graph structure, which relies on qualitative abstractions to overcome non-uniform sampling and to capture the semantics of the interactions corresponding to the changes and deviations from normality of variables of interest over time. Using the assumption that similar templates of small interactions are responsible for the outcomes (as prevalent in the medical domains), we reformulate the discovery task to retrieve the most-likely templates from the data.Comment: 8 pages, 3 figures. Accepted for publication in the European Conference of Artificial Intelligence (ECAI 2020

An Efficient Constructive Heuristic to Balance Trade-Offs Between Makespan and Flowtime in Permutation Flow Shop Scheduling

Balancing trade-offs between production cost and holding cost is critical for production and operations management. Utilization of a production line affects production cost, which relates to makespan, and work-in-process (WIP) inventories in a production line affect holding cost, which relate to flowtime. There are trade-offs between two objectives, to minimize makespan and to minimize flowtime. Without addressing trade-off balancing issues in flow shop scheduling, WIP inventories are still high in manufacturing, generating unnecessary holding cost. However, utilization is coupled with WIP inventories. Low WIP inventory levels might lower utilization and generate high production cost. Most existing constructive heuristics focus only on single-objective optimization. In the current literature, the NEH heuristic proposed by Nawaz, Enscore, and Ham (1983) is the best constructive heuristic to minimize makespan, and the LR heuristic proposed by Liu and Reeves (2001) is the best to minimize flowtime. In this paper, we propose a current and future deviation (CFD) heuristic to balance trade-offs between makespan and flowtime minimizations. Based on 5400 randomly generated instances, 120 instances in Taillard’s benchmarks, and one-year historical records of operating room scheduling from University of Kentucky HealthCare (UKHC), our CFD heuristic outperforms the NEH and LR heuristics on trade-off balancing, and achieves the most stable performances from the perspective of statistical process control (SPC)

Operating Room Planning under Surgery Type and Priority Constraints

AbstractOperating room (OR) planning is critical in healthcare systems to reduce cost and improve the efficiency of OR scheduling. The OR planning problem is complicated, involving many conflicting factors, such as overtime and idle time, both of which affect OR utilization and consequently affect cost to a hospital. Allocating different types of surgeries into OR blocks affects the setup cost, whereas priorities of surgeries affect OR block scheduling. Surgery durations affect both OR utilization and OR block scheduling. Traditionally, one important method for OR block scheduling is the bin packing model, and the longest processing time (LPT) rule is the most commonly used method to generate the initial sequence for bin packing. In this study. We propose a multistep approach and a priority-type-duration (PTD) rule to generate the initial sequence for bin packing. The results of our case studies show that our PTD rule outperforms the LPT rule based on the cost to OR scheduling

Stochastic BI-Level Optimization Models for Efficient Operating Room Planning

Within a hospital, the operating room (OR) department has the largest cost and revenue. Because of the aging population, the demand for surgical services has been increasing sharply in recent years. At the other hand, the rate of OR capacity expansion is lower than the rate of increasing demand. As a result, OR managers must leverage their resources by efficient OR planning. OR planning is challenging because of multiple competing\conflicting objectives such cost minimization and throughput maximization. Inherent uncertainty in the surgical procedures and patients arrivals complicate the decision making process. This increases the risk of non-realization of the system objectives. In this paper, stochastic bi-level optimization models were formulated to optimize total cost and throughput of ORs under the presence of uncertainties in patient arrivals and case times. Newsvendor model and chance-constrained optimization method were used to optimize multiple objectives under the presence of uncertainties. Using historical data, a simulation model was established to validate the results of optimization models. Using statistical process control (SPC) stability of each model was investigated. Using bi-level optimization, we addressed managerial preferences over total cost and throughput. Optimizing one objective may lead to compromise on the optimality of the other objective, which generates trade-offs. Using a trade-off balancing model, we found solutions that minimize the sum of deviations from the best solutions for both total cost and throughput. Trade-off balancing optimization models may lead to better solutions, compared to traditional multi-objective optimization models. The results of this paper are applicable to manufacturing systems, where managers face multiple objectives and uncertainties in the system

Quantifying Health Inequalities Induced by Data and AI Models

AI technologies are being increasingly tested and applied in critical environments including healthcare. Without an effective way to detect and mitigate AI induced inequalities, AI might do more harm than good, potentially leading to the widening of underlying inequalities. This paper proposes a generic allocation-deterioration framework for detecting and quantifying AI induced inequality. Specifically, AI induced inequalities are quantified as the area between two allocation-deterioration curves. To assess the framework’s performance, experiments were conducted on ten synthetic datasets (N>33,000) generated from HiRID - a real-world Intensive Care Unit (ICU) dataset, showing its ability to accurately detect and quantify inequality proportionally to controlled inequalities. Extensive analyses were carried out to quantify health inequalities (a) embedded in two real-world ICU datasets; (b) induced by AI models trained for two resource allocation scenarios. Results showed that compared to men, women had up to 33% poorer deterioration in markers of prognosis when admitted to HiRID ICUs. All four AI models assessed were shown to induce significant inequalities (2.45% to 43.2%) for non-White compared to White patients. The models exacerbated data embedded inequalities significantly in 3 out of 8 assessments, one of which was >9 times worse