Michael Samudra

Operating Room Planning and Scheduling

Operating room (OR) planning and scheduling decisions involve the coordination of patients, medical staff, and hospital facilities. The patients arriving to the hospital are assigned to a surgery date and a surgery time slot. At the time of surgery, a suitable OR, the attending surgeon, supporting anesthesiologists, nurses, and, after the surgery, rooms in secondary facilities such as post-anesthesia care unit (PACU), intensive care unit (ICU), and ward need to be available. In order to deal with the complexity and the variety of problems faced in OR scheduling, it is useful to involve methods from operations research. In this chapter, we review the recent literature on the application of operations research to OR planning and scheduling. We start by discussing the impact of planning and scheduling of the ORs on the overall performance of a hospital. Next, we discuss the criteria for included publications and summarize the structure of Cardoen et al. (Eur J Oper Res 201:921–932, 2010) that served as the guideline for organization of this chapter. In the remainder of the chapter, we describe the evolution of the literature over the last 10 years with regard to the patient type, the different performance measures, the decision that has to be made, the incorporation of uncertainty, the operations research methodology, and the applicability of the research. Moreover, each of these evolutions will be demonstrated with a short review of some relevant papers. This chapter ends with conclusions and a discussion of interesting topics for further research.

Scheduling operating rooms: achievements, challenges and pitfalls

In hospitals, the operating room (OR) is a particularly expensive facility and thus efficient scheduling is imperative. This can be greatly supported by using advanced methods that are discussed in the academic literature. In order to help researchers and practitioners to select new relevant articles, we classify the recent OR planning and scheduling literature into tables regarding patient type, used performance measures, decisions made, OR up- and downstream facilities, uncertainty, research methodology and testing phase. Based on these classifications, we identify trends and promising topics. Additionally, we recognize three common pitfalls that hamper the adoption of research results by stakeholders: the lack of a clear choice of authors on whether to target researchers (contributing advanced methods) or practitioners (providing managerial insights), the use of ill-fitted performance measures in models and the failure to understandably report on the hospital setting and method-related assumptions. We provide specific guidelines that help to avoid these pitfalls. First, we show how to build up an article based on the choice of the target group (i.e., researchers or practitioners). Making a clear distinction between target groups impacts the problem setting, the research task, the reported findings, and the conclusions. Second, we discuss points that need to be considered by researchers when deciding on the used performance measures. Third, we list the assumptions that need to be included in articles in order to enable readers to decide whether the presented research is relevant to them.

Due time driven surgery scheduling

In many hospitals there are patients who receive surgery later than what is medically indicated. In one of Europe’s largest hospitals, the University Hospital Leuven, this is the case for approximately every third patient. Serving patients late cannot always be avoided as a highly utilized OR department will sometimes suffer capacity shortage, occasionally leading to unavoidable delays in patient care. Nevertheless, serving patients late is a problem as it exposes them to an increased health risk and should be avoided whenever possible. In order to improve the current situation, the delay in patient scheduling had to be quantified and the responsible mechanism, the scheduling process, had to be better understood. Drawing from this understanding, we implemented and tested realistic patient scheduling methods in a discrete event simulation model. We found that it is important to model non-elective arrivals and include elective rescheduling. Modeling rescheduling ensures that OR related performance measures, such as overtime, will only loosely depend on the chosen patient scheduling method. We also found that capacity considerations should guide both patient scheduling and replanning related decision making. This is the case as those scheduling strategies that ensure that OR capacity is efficiently used will also result in a high number of patients served within their medically indicated time limit. An efficient use of OR capacity can be achieved, for instance, by serving patients first come, first served. As applying first come, first serve might not always be possible in a real setting, we found it is important to allow for patient replanning.

Scheduling Operating Rooms: Achievements, Challenges and Pitfalls

In hospitals, the operating room (OR) is a particularly expensive facility and thus efficient scheduling is imperative. This can be greatly supported by using advanced methods that are discussed in the academic literature. In order to help researchers and practitioners to select new relevant articles, we classify the recent OR planning and scheduling literature into tables using patient type, used performance measures, decisions made, OR supporting units, uncertainty, research methodology and testing phase. Additionally, we identify promising practices and trends and recognize common pitfalls when researching OR scheduling. Our findings indicate, among others, that it is often unclear whether an article mainly targets researchers and thus contributes advanced methods or targets practitioners and consequently provides managerial insights. Moreover, many performance measures (e.g., overtime) are not always used in the correct context. Furthermore, we see that important information that would allow readers to determine whether the reported research results are relevant to them is often missing. In order to avoid these pitfalls, we conclude that researchers need to state whether they target researchers or practitioners, motivate the choice of the used performance measures and mention both setting and method specific assumptions.