Operating rooms scheduling

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Abstract

Many healthcare institutions have been researching tools to reduce costs and to ensure efficient use of hospital facilities. Operating rooms are considered among the most costly hospital facilities. In the present work, a two-step approach for operating rooms scheduling is introduced. The first step consists of assigning surgical operations to operating rooms. The second step consists of sequencing the assigned operations with the objective of improving operating room use while taking into account the various resource-related constraints and the specifications of the operations processes. Two strategies for operations sequencing are presented: (1) operation assignment to operating rooms obtained at the first step is not reconsidered, (2) operation assignment to operating rooms is redefined in order to be less constrained. Computational experiments performed on a set of randomly generated problems are used to compare the two strategies.

Introduction

The operating room represents a bottleneck in most hospitals. In addition, it can consume more than 9% of a hospital's annual budget (Gordon et al., 1988). Effective scheduling of the operation rooms, for the purpose of reducing costs while maintaining a good quality of care, has become one of the major priorities of the healthcare institutions.

Operating rooms scheduling determines the surgical operations (hereafter referred to as “operations”) to be performed in the surgical center of a hospital, as well as the resources assigned to each operation, over a period of a week or a day. In the context of health expenses control, operating rooms scheduling should obviously develop targets for cost reduction and resource use improvement.

Regardless of the model being used to develop the operating rooms schedule, having an accurate prediction of the operating time required for each surgery type is a prerequisite to an effective use of the operating rooms. However, the estimation of an operation execution time is not an easy task because it depends on the pathology of the patient, which can be partially known, and on the surgeon's expertise (Wright et al., 1996; Dexter and Macario, 1996).

Few studies in the literature address the issue of reducing costs through a better use of the operating rooms. Dexter (2000) examines the decision to move the last case of the day in an operating room to another empty operating room in order to decrease overtime costs. Dexter and Macario (1999) use simulation to determine whether small decreases in surgical or anesthetic procedures allow for an additional case to be scheduled in an operating room during regular working hours. Other recent studies introduce methods for constructing the operating room schedule (Guinet and Chaabane, 2003; Kharraja et al., 2002). Marcon et al., 2001a, Marcon et al., 2001b present a tool to assist in negotiating the schedule between the different actors of the surgical center. This negotiation is based on the estimation of the “risk of no realization” of a given operation. The objective of this indicator is to assess the deviation of the projected program from the one that will be actually achieved.

Generally, operating room actors take part in the construction of the operating schedule in an intuitive manner. Hence, the introduction of tools and methods for optimizing the operations of a surgical center introduces a new managerial culture. Although this new concept might restrict the authority of some actors, there is a general consensus about the need to construct an operating room schedule that maximizes the resource utilization.

In this present work, we propose a two-step approach to address the daily operating room scheduling problem. The first step consists of assigning operations to operating rooms. The second step deals with operations sequencing. The remainder of this paper is organized as follows: Section 2 presents the operating room scheduling problem. In Section 3, the first step of the proposed approach is introduced. The second step is described in Section 4. Computational experiments and results are presented in Section 5. As a conclusion, some future extensions of this work are discussed.

Section snippets

Problem statement

The objective of the daily operating room schedule is to determine the set of operations to undertake by allocating proper resources and to specify the time of their execution.

Within a surgical center, a patient may follow one of many possible paths, depicted in Fig. 1.

The typical sequences followed by planned patients are given below:

  • Suite of regular wards → Operating Room → Recovery Room → Suite of regular wards, or

  • Suite of regular wards → Operating Room → Recovery Room → Intensive Care Unit

Operation assignment

Operation assignment to operating rooms fixes the patients to be operated on during a given day. At the end of each day, we propose to determine the operating room schedule of the next operating day. Thus, perturbations which occur in the operating rooms during one day are taken into account when constructing the schedule of the next day. Indeed, daily operation assignment can be seen as an update of the operating room master plan which fixes the operations to undertake each day over a horizon

Operation sequencing

At the end of the surgical act, a patient has to be transferred to a bed in the recovery room where he receives postanesthesia procedure (except for some surgical acts which corresponding postanesthesia procedure requires the operating room). Patient transfer to a recovery room without waiting time in the operating room is respected unless the number of recovery room beds and the number of nurses are not well sized compared to the number of operating rooms. Here, we suppose that the number of

Experimentation

In order to evaluate the proposed models, 25 problem instances of different sizes have been tested. They can be divided into five subsets. Each subset is composed of five problem instances which are characterized by the same number of operations to schedule (N1: 11, 12, 13, 14, and 15). However, instances of the same subset differ in the execution times.

In all problem instances, we consider the case of a surgical center composed of three operating rooms. For all operating rooms, the regular

Conclusion

In this paper, we present a two-step approach to address the operating rooms scheduling problem. The first step consists of assigning operations to operating rooms. The second step consists of sequencing operations which have been assigned to an operating room at the previous step. In view of the sequencing step, two strategies have been presented: (1) pure sequencing; (2) sequencing with some re-assignment. Indeed, operation assignment to operating rooms is reconsidered in the second strategy.

Acknowledgements

The authors thank the group of university and professional partners of HRP project as well as professionals at general surgery service “Beau Séjour” of the Tunisian university hospital Charles Nicolle. We are particularly grateful to N. Smolski, J.P. Viale, N. Nejeh and M. Hani for their availability and the information they provided. The authors also want to thank both referees for their constructive suggestions which led to substantial improvements of an earlier version of this paper.

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