A three-phase approach for operating theatre schedules

Abstract

In this paper we develop a three-phase, hierarchical approach for the weekly scheduling of operating rooms. This approach has been implemented in one of the surgical departments of a public hospital located in Genova (Genoa), Italy. Our aim is to suggest an integrated way of facing surgical activity planning in order to improve overall operating theatre efficiency in terms of overtime and throughput as well as waiting list reduction, while improving department organization. In the first phase we solve a bin packing-like problem in order to select the number of sessions to be weekly scheduled for each ward; the proposed and original selection criterion is based upon an updated priority score taking into proper account both the waiting list of each ward and the reduction of residual ward demand. Then we use a blocked booking method for determining optimal time tables, denoted Master Surgical Schedule (MSS), by defining the assignment between wards and surgery rooms. Lastly, once the MSS has been determined we use the simulation software environment Witness 2004 in order to analyze different sequencings of surgical activities that arise when priority is given on the basis of a) the longest waiting time (LWT), b) the longest processing time (LPT) and c) the shortest processing time (SPT). The resulting simulation models also allow us to outline possible organizational improvements in surgical activity. The results of an extensive computational experimentation pertaining to the studied surgical department are here given and analyzed.

A stochastic dynamic program for the single-day surgery scheduling problem

“…For hospitals using block schedules, the literature on surgery scheduling describes the problem as consisting of three stages: (1) determining the amount of OR time to allocate to various surgical specialties, (2) creating a block schedule implementing the desired allocations, and (3) scheduling individual patients into available time (Blake & Donald, 2002;Santibañez, Begen, & Atkins, 2007;Testi, Tanfani, & Torre, 2007). First stage decisions typically reflect the long-term strategic goals of hospital management, such as meeting the demand for surgical specialties' services, achieving desired levels of patient throughput, or maximizing revenue (Blake & Carter, 2002;Gupta, 2007;Santibañez et al, 2007;Testi et al,2007). The second and third stages represent medium-and short-term operational decisions, respectively, but differ markedly in their objectives.…”

“…However, no existing work in the surgery scheduling literature to date addresses all three of these components simultaneously. Some recent papers incorporate block schedules as constraints in individual patient scheduling models, but in each case the schedules are determined all at once, rather than evolved dynamically over time Pham & Klinkert, 2008;Testi et al, 2007),. A pair of papers analyze different block release dates and conclude that the timing of the block release has little impact on OR efficiency (Dexter, Traub, & Macario, 2003;Dexter & Macario, 2004).…”

Stochastic Reactive Scheduling Model for Operating Rooms Considering the Moral and Human Virtues

“…Testi et al (2007) in a certain case where the type of patients is unknown, have developed a three-step approach for the operating room weekly scheduling. This paper proposes an integrated approach for planning surgical operations, to improve efficiency of operating room performance and reduce overtime and patient waiting time.…”

Operating Room Scheduling and Adaptive Control Using a Priority First Fit Decreasing Heuristic

“…Static OR scheduling models tend to ignore pre-and post-operative influences that impact OR utilization and performance (Magerlein & Martin, 1978;Cardoen, Demeulemmeester, & Belien, 2010). A systems engineering perspective enables a more fluid approach to OR scheduling that takes demand uncertainty and system interdependencies into consideration (e.g., Testi, Tanfani, & Torre, 2007;Vanberket et al, 2011).…”