On the design of custom packs: grouping of medical disposable items for surgeries

Abstract

A custom pack combines medical disposable items into a single sterile package that is used for surgical procedures. Although custom packs are gaining importance in hospitals due to their potential benefits in reducing surgery setup times, little is known on methodologies to configure them, especially if the number of medical items, procedure types and surgeons is large. In this paper, we propose a mathematical programming approach to guide hospitals in developing or reconfiguring their custom packs. In particular, we are interested in minimising points of touch, which we define as a measure for physical contact between staff and medical materials. Starting from an integer non-linear programming model, we develop both an exact linear programming (LP) solution approach and an LP-based heuristic. Next, we also describe a simulated annealing approach to benchmark the mathematical programming methods. A computational experiment, based on real data of a medium-sized Belgian hospital, compares the optimised results with the performance of the hospital's current configuration settings and indicates how to improve future usage. Next to this base case, we introduce scenarios in which we examine to what extent the results are sensitive for waste, i.e. adding more items to the custom pack than is technically required for some of the custom pack's procedures, since this can increase its applicability towards other procedures. We point at some interesting insights that can be taken up by the hospital management to guide the configuration and accompanying negotiation processes.Keywords: health care services; combinatorial optimisation; integer linear programming; case study IntroductionThe provision of accessible and cost-efficient health care is seen as one of the major service challenges of today's society. In 2012, member countries of the Organisation for Economic Co-operation and Development spent on average 9.5% of their gross domestic product on health care (OECD 2012). Hospitals contribute for about one-third of these national health expenditures (Poisal et al. 2007). One unit that is of particular interest within hospitals is the operating theatre. Since this facility generates about 42% of a hospital's revenue and a proportionate share of its costs, it has a significant impact on financial performance. Improving the surgical throughput by just one additional case per day per operating room may generate additional revenue of 4-7 million dollar for an average-sized hospital (HFMA 2005).Multiple strategies exist to increase patient throughput in the operating room. First, one can adjust the planning and scheduling practice within the operating theatre and its related facilities. Zhang et al. (2009) show how an improved assignment of capacity to specialties reduces inpatient's length of stay (LOS) waiting for the surgery. By reducing unnecessary LOS and increasing operating theatre utilisation, they positively impact patient throughput. We refer to Cardoen, Demeulemeester, and Beliën (2010), Guerriero andGuido (2011) andM...

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