Trade-Offs in Operating Room Planning for Electives and Emergencies: A Review

Abstract

The planning of the operating rooms (ORs) is a difficult process due to the different stakeholders involved. The real complexity, however, results from various sources of variability entering the processes. These uncertain processes cannot be ignored since they greatly influence the trade-offs between the hospital costs and the patient waiting times. As a result, a need for policies guiding the OR manager in handling the trade-offs arises. Therefore, researchers have investigated different possibilities to incorporate non-elective patients in the schedule with the goal of maximizing both patient-and hospital-related measures. This paper reviews the literature on OR planning where both elective and non-elective patient categories are involved. It shows the various policies, the differences and similarities in the research settings and the resulting outcomes, whether they are beneficial or not. We find that the dedicated and the flexible policy are mostly pursued, but the setting and the assumptions of the reviewed papers vary widely. Decisions on both operational policies as well as on capacity are required to assure timely access and efficiency, which are the two main drivers for the problem at hand. Furthermore, the policy choice impacts the number of schedule disruptions and the OR utilization. However, results on the overtime and the patient waiting time are partly contradicting. The review shows that some policies have already received considerable attention, but the question of which policies are most appropriate is not yet fully answered. Neither has the full spectrum of policies been explored yet. Consequently, this topic provides several areas for future research, which are outlined throughout the paper.

Case mix classification and a benchmark set for surgery scheduling

“…However, in healthcare scheduling, no widely used benchmark instances exist other than for the nurse scheduling problem (Vanhoucke and Maenhout 2007). Van Riet and Demeulemeester (2014) underline in a recent operating room planning review that test instances are needed that cover realistic hospital settings in order to align the operating room planning research.…”

Managing urgent care in hospitals

“…For example, using a flexible policy (2) is stated to both decrease [253] and increase [68] overtime of ORs. Also, in the literature there are contradictory results between policies [238]. The performance of a used policy is affected by the characteristics of the hospital, and thus differences in hospital characteristics may account for the difference in results between papers.…”

“…Work that specifically addresses non-elective surgeries, and takes such surgeries into account on a tactical and/or operational level is less common. Two recent literature reviews that give an overview of OR planning and scheduling literature, taking into account non-electives and the trade-offs they pose, are Ferrand et al [70] and Van Riet et al [238]. Van Riet et al [238] note that it is still unclear what the effect is of different settings on the possible performance measures, and that a key question is how to determine what level of demand and patient mix is required before a specific policy should be pursued.…”

“…Hospitals that perform surgery on both elective and emergency patients are faced with the problem of how to deal with arriving emergency patients [238]. In this chapter we study three emergency surgery scheduling policies, commonly encountered both in practice and in the literature.…”

“…In addition to case mixes, we vary the number of patients treated (in total) per year, as well as the total number of available ORs. Finally, the percentage of emergency patients is varied, to further specify the case mix, as different hospitals have different numbers of emergency arrivals [238]. Table 5.3 lists the varied case characteristics.…”