Comparing two operating-room-allocation policies for elective and emergency surgeries

Abstract

When organizing the operating theatre and scheduling surgeries, hospitals face a trade-off between the need to be responsive to emergency cases and to conduct scheduled elective surgeries efficiently. We develop a simulation model to compare a flexible and a focused resource-allocation policy. We evaluate these two policies on patient and provider outcome measures, including patient wait time and physician overtime. We find that the focused policy results in lower elective wait time and lower overtime, which leads to the conclusion that electives benefit more from the elimination of emergency disruptions than what they lose from the reduced access to operating rooms. Emergency patient wait time, however, increases significantly as we shift from the flexible to the focused policy. The sensitivity analysis showed that average emergency wait time can decrease as the processing time variability increases. The trade-off between efficiency and responsiveness calls for additional research on other operating-room-allocation policies.

Managing urgent care in hospitals

“…Table 2.4 lists the publications per department and planning level. [68,199,225,226,253,263] tactical [2, 8, 17, 18, 68, 93, 125, 147, 171, 195, 225-228, 249, 262, 263] operational [2, 18, 32, 61, 63, 64, 77, 93, 106, 113, 126, 153-156, 184, 192, 201, 207, 247, 249 [33,35,73,79,90,120,123,141,143,174,204,215,260] operational [16,73,84,112,143,172,202,229,234,240] N/A 2.3. Results…”

“…At the strategic level, ambulatory services are taken into account in studies that model entire patient pathways [33,90,157], and resource capacity is dimensioned across services and wards. For the operating theater, strategic decision making involves the capacity dimensioning of OR capacity among elective and urgent patient types [68,199,226,253,263]. Not only the number of needed ORs is determined [199], but also how OR time is assigned to different patients types (e.g., evaluate the use of dedicated emergency ORs) [68,225,253].…”

“…Tactical operating room planning mostly considers the allocation of capacity to patient groups, or creating Master Surgery Schedules (MSS) in which available OR time is allocated to medical specialties [8,68,93,125,169,195,228,262]. Taking into account non-elective patients presents additional challenges.…”

“…Not only are surgery durations stochastic, the arrival of non-elective patients is generally not known in advance, and the question not only involves when and how much capacity to allocate to non-electives, but also how to account for non-electives. To facilitate the timely treatment of non-elective patients, these patients may be treated in dedicated emergency ORs [8,32,68,199,228,253], in regular ORs by interrupting the elective program [2,68,126,155,253], or a combination of both [68,262]. However the performance of using dedicated ORs (or not) depends on the underlying case settings such as patient mix, volume, and number of available ORs, because conclusions differ on the effectiveness of dedicated ORs [68,195].…”

“…To facilitate the timely treatment of non-elective patients, these patients may be treated in dedicated emergency ORs [8,32,68,199,228,253], in regular ORs by interrupting the elective program [2,68,126,155,253], or a combination of both [68,262]. However the performance of using dedicated ORs (or not) depends on the underlying case settings such as patient mix, volume, and number of available ORs, because conclusions differ on the effectiveness of dedicated ORs [68,195]. When urgent patients are treated in the same ORs as elective patients, they are taken into account as by allocating slack [2,113,126,153,207,225,226,247] where some part of the ORs is left unused by electives for urgent arrivals.…”