Tactical blueprints for surgical weeks – An integrated approach for operating rooms and intensive care units

Abstract

Decisions on the number of surgeries to perform during a typical week in an operating room (OR) generally affect downstream resources such as intensive care units (ICU), recovery rooms, or regular inpatient wards. Since capacity of e.g. ICUs is highly restricted, this bottleneck plays an important role in the management of an efficient flow of surgical patients through the system. This paper aims to provide hospital decision makers with easy-to-follow guidelines for the daily patient scheduling decisions and presents a novel chance-constraint optimisation model to develop efficient admission templates for elective surgeries on a tactical level. With a given patient mix, we decide on the number of surgeries that can realistically be treated during a typical week, with respect to limited resources of OR and ICU and considering stochastic demand. The benefit of such templates is exemplified using a dedicated simulation model in a realistic case study. The simulation model rebuilds daily operations in OR and ICU and allows to mimic typical decision making in OR and ICU. Computational studies show that continually applying such templates as admission guidelines leads to a well-utilised OR and efficiently used ICUs. The extensive simulation studies confirm that the template plans obtained from the chance-constraint optimisation model can provide guidance for an operating room planner.