Improving operational effectiveness of tactical master plans for emergency and elective patients under stochastic demand and capacitated resources

Abstract

This paper develops a two-stage planning procedure for master planning of elective and emergency patients while allocating at best the available hospital resources. Four types of resources are considered: operating theatre, beds in the medium and in the intensive care units, and nursing hours in the intensive care unit. A tactical plan is obtained by minimizing the deviations of the resources consumption to the target levels of resources utilization. Some capacity is reserved for emergency care. To deal with the deviation between actually arriving patients and the average number of patients on which the tactical plan is based, we consider the option of planning a higher number of patients (overplanning). To adapt the tactical plan to the actual stream of elective patients, we also consider flexibility rules. Overplanning and flexibility leads to a weekly schedule of elective patients. This schedule is modified to account for emergency patients. Scheduled elective patients may be cancelled and emergency patients may be sent to other hospitals. Cancellations rules for both types of patients rely on the possibility to exceed the available capacities. Several performance indicators are defined to assess patient service/dissatisfaction and hospital efficiency. Simulation results show a trade-off between hospital efficiency and patient service. We also obtain a rank of the different strategies: overplanning, flexibility and cancellation rules.Keywords: operation theatre planning, intensive and medium care, emergency and elective patients, overplanning, cancellation rules, operational schedule of patients, master surgical schedule.

Balancing operating theatre and bed capacity in a cardiothoracic centre

“…i d was estimated assuming that the contributions from the three components of demand identified in Table 1 are independent with i d (j) being the mean demand on day i for component j of demand (j=1..3). Other studies (Adan et al, 2011) have formulated similar problems but adopted more complex distributions of ICU bed-stay. However, the exponential nature of the length of stay model permits a comparatively simple formulation reflecting the remaining patients from previous days' admissions to the ICU and the 7-day cycle of activity.…”

Integrated decision making in healthcare : an operations research and management science perspective

“…Methods: computer simulation [57,138,291,478], Markov processes [365], mathematical programming [3,4], literature review [49,224].…”

“…When the schedule is carried out, unplanned events, such as emergency patients, extended surgery duration and equipment breakdown may disturb the surgical case schedule [3,338]. Hence, the surgical case schedule often has to be reconsidered during the day to mitigate increasing staff overtime, patient waiting time and resource idle time.…”

“…It is established by developing an admission plan that prescribes how many surgeries of each patient group to perform on each day, taking the block schedule into account [4]. Balancing the number of scheduled surgical cases throughout the week prevents high variance in utilization of involved surgical resources, such as operating rooms and recovery beds, and downstream inpatient care resources, such as ICU and general ward beds [3,4,31,291,336,478]. Resource utilization can be improved by using call-in patients [49] and overbooking [57].…”

“…In practice, the operating room planning is generally done under the assumption that a free bed is available for postoperative care [293], which may result in surgery cancellations. Therefore, both for inpatient and surgical care services coordinated planning is beneficial [3,238].…”