Scheduling Elective Surgeries with Emergency Patients at Shared Operating Rooms

Abstract

O perating rooms (ORs) are the greatest source of revenues for hospitals and also their largest cost centers. When scheduling surgeries, hospitals face a trade-off between the need to conduct planned elective surgeries and the need to be responsive to emergency cases. However, scheduling ORs, especially at Level-1 trauma hospitals, is challenging due to significant uncertainties in the arrivals of patients requiring emergent surgery. The issue of allocating limited capacity to emergent surgery cases while scheduling elective patients has major policy implications. We develop a model for allocating the OR capacity to elective patients in such a way that the emergency patients who arrive randomly can be accommodated without incurring excessive delays. The objective is to develop a framework for aggregate weekly schedules and generate detailed daily schedules that minimize the total cost of the ORs' expected operating time, idle time, and overtime. We present optimization procedures for generating effective schedules and rescheduling procedures that adjust the schedules of elective patients affected by emergency arrivals. Initially, the procedures assume deterministic surgery times for elective patients; the procedures are then extended to include stochastic surgery times. We show that for a given arrival rate of emergency patients, the total expected cost is convex in the weekly load of elective surgeries being scheduled. Numerical experiments are devised to obtain total expected cost curves for various emergency arrival rates. Using these curves, the optimal capacity allocation of ORs to elective patients can be determined as a function of the emergency arrival rate.

Efficient scheduling of emergency surgeries by adjusting the schedule of elective surgeries

“…Van Essen et al provide a decision support system that constructs schedules by considering patients and wards desirability as different stakeholders of the SSP [21]. Jung et al consider a class of parallel machines scheduling for the SSP [22]. Aringhieri et al cover the demands of some patients for surgery over the weekends and consider both the OR time blocking problem and the SSP together [23].…”

OP-Planung – der Einsatz quantitativer Methoden zur Entscheidungsunterstützung

“…Auch Jung u. Mitarb. [38] Zum Schluss soll festgehalten werden, dass insbesondere die gerade vorgestellten OR-Methoden in der OP-Planungspraxis deutscher Krankenhäuser bisher noch keine breite Anwendung finden. Während die beschriebene grundsätzliche Aufteilung der einzelnen Entscheidungsprobleme auf die verschiedenen Planungsebenen durchaus auch so in der Praxis gelebt wird, müssen für die Etablierung von vor allem den komplexeren unter den mathematisch-orientierten Planungsmethoden in absehbarer Zukunft zuerst noch entsprechende Voraussetzungen geschaffen werden.…”

Multi-resource scheduling and routing for emergency recovery operations

“…Jung et al [ 24 ] develop a model for allocating operating room capacity in hospitals to scheduled patients while accommodating randomly arrived emergency patients without incurring excessive delays. The aim is to develop a framework for aggregating weekly schedules and generating detailed daily schedules that minimise the total cost of the expected operating time, idle time, and overtime of the operating rooms.…”