Scheduling elective patients based on sequence-dependent setup times in an open-heart surgical department using an optimization and simulation approach
Abstract:The surgery ward is the most expensive and profitable section of a hospital. The decisions made in this section therefore produce significant effects on the overall performance of the hospital. Planning and scheduling of the surgeries in the operating rooms would obviously lead to the enhancement of the performance of the operating rooms. The setup time of the operating rooms is a very important factor in initiating next surgeries and consequently in the scheduling of elective patients. The preparation time is… Show more
“…The model traced the treatment pathway of each patient through different departments – ED, IPD, and OPD. Hamid et al 42 focus on patients requiring elective open-heart surgery and develop a two-stage optimization and simulation approach to first mathematically determine optimal surgery schedules for the operating room, and then using DES determine the minimum number of beds in the downstream ICU to ensure an adequate patient service level. Of the second type, Lowery 43 developed a simulation model of a tertiary care hospital with a focus on the surgical suite and critical care area.…”
Section: Background and Literature Reviewmentioning
We present discrete-event simulation models of the operations of primary health centers (PHCs) in the Indian context. Our PHC simulation models incorporate four types of patients seeking medical care: outpatients, inpatients, childbirth cases, and patients seeking antenatal care. A generic modeling approach was adopted to develop simulation models of PHC operations. This involved developing an archetype PHC simulation, which was then adapted to represent two other PHC configurations, differing in numbers of resources and types of services provided, encountered during PHC visits. A model representing a benchmark configuration conforming to government-mandated operational guidelines, with demand estimated from disease burden data and service times closer to international estimates (higher than observed), was also developed. Simulation outcomes for the three observed configurations indicate negligible patient waiting times and low resource utilization values at observed patient demand estimates. However, simulation outcomes for the benchmark configuration indicated significantly higher resource utilization. Simulation experiments to evaluate the effect of potential changes in operational patterns on reducing the utilization of stressed resources for the benchmark case were performed. Our analysis also motivated the development of simple analytical approximations of the average utilization of a server in a queueing system with characteristics similar to the PHC doctor/patient system. Our study represents the first step in an ongoing effort to establish the computational infrastructure required to analyze public health operations in India and can provide researchers in other settings with hierarchical health systems, a template for the development of simulation models of their primary healthcare facilities.
“…The model traced the treatment pathway of each patient through different departments – ED, IPD, and OPD. Hamid et al 42 focus on patients requiring elective open-heart surgery and develop a two-stage optimization and simulation approach to first mathematically determine optimal surgery schedules for the operating room, and then using DES determine the minimum number of beds in the downstream ICU to ensure an adequate patient service level. Of the second type, Lowery 43 developed a simulation model of a tertiary care hospital with a focus on the surgical suite and critical care area.…”
Section: Background and Literature Reviewmentioning
We present discrete-event simulation models of the operations of primary health centers (PHCs) in the Indian context. Our PHC simulation models incorporate four types of patients seeking medical care: outpatients, inpatients, childbirth cases, and patients seeking antenatal care. A generic modeling approach was adopted to develop simulation models of PHC operations. This involved developing an archetype PHC simulation, which was then adapted to represent two other PHC configurations, differing in numbers of resources and types of services provided, encountered during PHC visits. A model representing a benchmark configuration conforming to government-mandated operational guidelines, with demand estimated from disease burden data and service times closer to international estimates (higher than observed), was also developed. Simulation outcomes for the three observed configurations indicate negligible patient waiting times and low resource utilization values at observed patient demand estimates. However, simulation outcomes for the benchmark configuration indicated significantly higher resource utilization. Simulation experiments to evaluate the effect of potential changes in operational patterns on reducing the utilization of stressed resources for the benchmark case were performed. Our analysis also motivated the development of simple analytical approximations of the average utilization of a server in a queueing system with characteristics similar to the PHC doctor/patient system. Our study represents the first step in an ongoing effort to establish the computational infrastructure required to analyze public health operations in India and can provide researchers in other settings with hierarchical health systems, a template for the development of simulation models of their primary healthcare facilities.
“…Because of that, their optimal and efficient management has become one of the challenges of governments and health sector managers in recent decades 45 . Many studies have used analytical and simulation methods to solve some of the problems in this field 20,30,32,36,38,46,47 . Whatever the complexity of the systems increases, analytical models are not responsive because they fail to capture the details.…”
Bed occupancy rate (BOR) is important for healthcare policymakers. Studies showed the necessity of using simulation approach when encountering complex real-world problems to plan the optimal use of resources and improve the quality of services. So, the aim of the present study is to estimate average length of stay (LOS), BOR, bed blocking probability (BBP), and throughput of patients in a cardiac surgery department (CSD) using simulation models. We studied the behavior of a CSD as a complex queueing system at the Farshchian Hospital. In the queueing model, customers were patients and servers were beds in intensive care unit (ICU) and post-operative ward (POW). A computer program based on the Monte Carlo simulation, using Python software, was developed to evaluate the behavior of the system under different number of beds in ICU and POW. The queueing simulation study showed that, for a fixed number of beds in ICU, BOR in POW decreases as the number of beds in POW increases and LOS in ICU increases as the number of beds in POW decreases. Also, based on the available data, the throughput of patients in the CSD during 800 days was 1999 patients. Whereas, the simulation results showed that, 2839 patients can be operated in the same period. The results of the simulation study clearly demonstrated the behavior of the CSD; so, it must be mentioned, hospital administrators should design an efficient plan to increase BOR and throughput of patients in the future.
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