Planning and scheduling of semi-urgent surgeries

Abstract

This paper investigates the trade-off between cancellations of elective surgeries due to semi-urgent surgeries, and unused operating room (OR) time due to excessive reservation of OR time for semi-urgent surgeries. Semi-urgent surgeries, to be performed soon but not necessarily today, pose an uncertain demand on available hospital resources, and interfere with the planning of elective patients. For a highly utilized OR, reservation of OR time for semi-urgent surgeries avoids excessive cancellations of elective surgeries, but may also result in unused OR time, since arrivals of semi-urgent patients are unpredictable. First, using a queuing theory framework, we evaluate the OR capacity needed to accommodate every incoming semi-urgent surgery. Second, we introduce another queuing model that enables a trade-off between the cancelation rate of elective surgeries and unused OR time. Third, based on Markov decision theory, we develop a decision support tool that assists the scheduling process of elective and semi-urgent surgeries. We demonstrate our results with actual data obtained from a department of neurosurgery.

Fig. 1

An example of the progression of the number of semi-urgent slots waiting at the start of the week (s  =  3)

Fig. 2

Number of semi-urgent slots performed in overtime: three different cases

Fig. 3

State space of the system

Fig. 4

(interrupted line) and for

Fig. 5

δ ^* for CC ₁ (s ^* = 13)

Fig. 6

δ _M for CC ₂ (s ^* = 11)

Fig. 7

δ ^* for CC ₃ (s ^* = 17 )