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Optimization of surgery sequencing and scheduling decisions under uncertainty

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Abstract

Operating rooms (ORs) are simultaneously the largest cost center and greatest source of revenues for most hospitals. Due to significant uncertainty in surgery durations, scheduling of ORs can be very challenging. Longer than average surgery durations result in late starts not only for the next surgery in the schedule, but potentially for the rest of the surgeries in the day as well. Late starts also result in direct costs associated with overtime staffing when the last surgery of the day finishes later than the scheduled shift end time. In this article we describe a stochastic optimization model and some practical heuristics for computing OR schedules that hedge against the uncertainty in surgery durations. We focus on the simultaneous effects of sequencing surgeries and scheduling start times. We show that a simple sequencing rule based on surgery duration variance can be used to generate substantial reductions in total surgeon and OR team waiting, OR idling, and overtime costs. We illustrate this with results of a case study that uses real data to compare actual schedules at a particular hospital to those recommended by our model.

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References

  1. Achieving operating room efficiency through process integration (2005) Technical report, Health Care Financial Management Association Report

  2. Surgical services reform: executive briefing for clinical leaders (2001) Technical report, Washington, DC, Clinical Advisory Board

  3. Bowers J, Mould G (2005) Ambulatory care and orthopaedic capacity planning. Health Care Manage Sci 8:41–47

    Article  Google Scholar 

  4. Denton BT, Gupta D (2003) A sequential bounding approach for optimal appointment scheduling. IIE Trans 35:1003–1016

    Article  Google Scholar 

  5. Blake JT, Carter M (1997) Surgical process scheduling: a structured review. J Soc Health Syst 5(3):17–30

    Google Scholar 

  6. Przasnyski Z (1986) Operating room scheduling: a literature review. AORN J 44(1):67–79

    Article  Google Scholar 

  7. Magerlein JM, Martin JB (1978) Surgical demand scheduling: a review. Health Serv Res 13(4):418–433

    Google Scholar 

  8. Sabria F, Daganzo CF (1989) Approximate expressions for queuing systems with scheduling arrivals and established service order. Transp Sci 23:159–165

    Google Scholar 

  9. PP Wang (1993) Static and dynamic scheduling of customer arrivals to a single-server system. Nav Res Logist 40:345–360

    Article  Google Scholar 

  10. Bailey N (1952) A study of queues and appointment systems in hospital outpatient departments, with special reference to waiting-times. J R Stat Soc A 14:185–189

    Google Scholar 

  11. Soriano A (1966) Comparison of two scheduling systems. Oper Res 14:388–397

    Google Scholar 

  12. Mercer A (1973) Queues with scheduled arrivals: a correction simplification and extension. J R Stat Soc B 35:104–116

    Google Scholar 

  13. Charnetski J (1984) Scheduling operating room surgical procedure with early and late completion penalty costs. J Oper Manag 5:91–102

    Article  Google Scholar 

  14. Ho C-J, Lau H-S (1992) Minimizing total cost in scheduling outpatient appointments. Manag Sci 38:750–764

    Article  Google Scholar 

  15. Weiss EN (1990) Models for determining the estimated start times and case orderings. IIE Trans 22(2):143–150

    Article  Google Scholar 

  16. Strum DP, Vargas LG, May JH (1999) Surgical subspecialty block utilization and capacity planning. Anesthesiol 90:1176–1185

    Article  Google Scholar 

  17. Vanden Bosch BP, Dietz DC (2000) Minimizing expected waiting time in a medical appointment system. IIE Trans 32:841–848

    Article  Google Scholar 

  18. Dexter F, Ledolter J (2005) Bayesian prediction bounds and comparisons of operating room times even for procedures with few or no historic data. Anesth Analg 103(6):1259–1267

    Google Scholar 

  19. Dexter F, Marcon E (2006) Impact of surgical sequencing on post anesthesia care unit staffing. Health Care Manage Sci 9:87–98

    Article  Google Scholar 

  20. Kleywegt AJ, Shapiro A, Homem-de MT (2001) The sample average approximation method for stochastic discrete optimization. SIAM J Optim 12(2):479–502

    Article  Google Scholar 

  21. Van Slyke RM, Wets RJ-B (1969) L-shaped linear programs with applications to optimal control and stochastic programming. SIAM J Appl Math 17:638–663

    Article  Google Scholar 

Download references

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Correspondence to Brian Denton.

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Denton, B., Viapiano, J. & Vogl, A. Optimization of surgery sequencing and scheduling decisions under uncertainty. Health Care Manage Sci 10, 13–24 (2007). https://doi.org/10.1007/s10729-006-9005-4

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