Innovative Applications of O.R.Operating room planning and scheduling: A literature review
Introduction
The managerial aspect of providing health services to patients in hospitals is becoming increasingly important. Hospitals want to reduce costs and improve their financial assets, on the one hand, while they want to maximize the level of patient satisfaction, on the other hand. One unit that is of particular interest is the operating theater. Since this facility is the hospital’s largest cost and revenue center [66], [82], it has a major impact on the performance of the hospital as a whole. Managing the operating theater, however, is hard due to the conflicting priorities and the preferences of its stakeholders [58], but also due to the scarcity of costly resources. Moreover, health managers have to anticipate the increasing demand for surgical services caused by the aging population [50]. These factors clearly stress the need for efficiency and necessitate the development of adequate planning and scheduling procedures.
In the past 60 years, a large body of literature on the management of operating theaters has evolved. Magerlein and Martin [83] review the literature on surgical demand scheduling and distinguish between advance scheduling and allocation scheduling. Advance scheduling is the process of fixing a surgery date for a patient, whereas allocation scheduling determines the operating room and the starting time of the procedure on the specific day of surgery. Blake and Carter [11] elaborate on this taxonomy in their literature review and add the domain of external resource scheduling, which they define as the process of identifying and reserving all resources external to the surgical suite necessary to ensure appropriate care for a patient before and after an instance of surgery. They furthermore divide each domain in a strategic, administrative and operational level. Przasnyski [102] structures the literature on operating room scheduling based on general areas of concern, such as cost containment or scheduling of specific resources. Other reviews, in which operating room management is covered as a part of global health care services, can be found in [16], [101], [109], [123].
The aim of this literature review paper is threefold. First, we want to provide an updated overview on operating room planning and scheduling that captures the recent developments in this rapidly evolving area. In order to maintain a homogeneous set of contributions, we restrict the focus to manuscripts that explicitly incorporate planning and scheduling considerations. Planning is described in [108] as ‘the process of reconciling supply and demand’ (i.e., dealing with capacity decisions). Scheduling is described as ‘defining the sequence and time allocated to the activities of an operation. It is the construction of a detailed timetable that shows at what time or date jobs should start and when they should end’. We do not enlarge the scope of the review to operating room management and hence exclude topics such as business process re-engineering, the impact of introducing new medical technologies, the estimation of surgery durations, staff rostering or facility design. Second, we want to structure the obtained information in such a way that research contributions can easily be linked to each other and compared on multiple facets, which should facilitate the detection of contributions that are within a specific researcher’s area of interest. In Section 2, we describe how the structure of this review paper contributes to this goal. Third, pooling literature in a detailed manner enables the identification of issues that are currently (not) well covered and examined.
We searched the databases Pubmed, Web of Science, Current Contents Connect and Inspec on relevant manuscripts. Furthermore, references that were cited in the manuscripts were reviewed for additional publications, which eventually led to a set of 247 manuscripts. As can be seen from Table 1, this set largely consists of articles published in scientific journals. Note that almost half of the contributions appeared in or after 2000, which clearly illustrates the increasing interest of researchers in this domain. Since the total number of manuscripts is large and our main interest is directed towards the recent advances proposed by the scientific community, we restrict the set of manuscripts to those published in or after 2000. We furthermore limit the contributions that are incorporated in this review to those that are written in English in order to augment the paper’s accessability. A detailed bibliography of the entire set of manuscripts, however, is provided in [20].
Section snippets
Organization of the review
Researchers frequently differentiate between strategic (long term), tactical (medium term) and operational (short term) approaches to situate their planning or scheduling problem. With respect to the operational level, a further distinction can be made between offline (i.e., before schedule execution) and online (i.e. during schedule execution) approaches. The boundaries between these major categories, however, may vary considerably for different settings and are hence often perceived as vague
Patient characteristics
Two major patient classes are considered in the literature on operating room planning and scheduling, namely elective and non-elective patients. The former class represents patients for whom the surgery can be well planned in advance, whereas the latter class groups patients for whom a surgery is unexpected and hence needs to be performed urgently.
As shown in Table 2, the literature on elective patient planning and scheduling is rather vast compared to the non-elective counterpart. Although
Performance measures
Various performance criteria are used to evaluate operating room planning and scheduling procedures. We distinguish between eight main performance measures, namely waiting time, throughput, utilization, leveling, makespan, patient deferrals, financial measures and preferences. We discuss the performance measures in the next paragraphs and clarify their meaning and importance by means of some interesting research contributions. An overview of the manuscripts, classified according to the
Decision delineation
A variety of planning and scheduling decisions with a resulting impact on the performance of the operating theater are studied in the literature. In Table 4, we provide a matrix that indicates what type of decisions are examined in the manuscripts, such as the assignment of a date (e.g., on Monday, on January 17th), a time indication (e.g., at 11 a.m.), an operating room (e.g., operating room 2, operating room of type A) or the allocation of capacity (e.g., three hours of operating room time).
Research methodology
The literature on operating room planning and scheduling exhibits a wide range of research methodologies that fit within the domains of operations management and operations research and that combine a certain type of analysis with some solution or evaluation technique.
Table 6 provides an overview of the ways in which operating room planning and scheduling problems are analyzed. While most of the problems are formulated and studied as a combinatorial optimization problem, many approaches can
Uncertainty
One of the major problems associated with the development of accurate operating room schedules or capacity planning strategies is the uncertainty inherent to surgical services. Deterministic planning and scheduling approaches ignore such uncertainty or variability, whereas stochastic approaches explicitly try to incorporate it. In Table 9, we list the relevant manuscripts based on their uncertainty incorporation.
Two types of uncertainty that seem to be well addressed in the stochastic
Applicability of research
Many researchers provide, next to the development of a model or a formulation, a thorough testing phase in which they illustrate the applicability of their research. Whether this applicability points at computational efficiency or at showing to what extent objectives may be realized, a substantial amount of data is desired. From Table 10, we notice that most of this data stems from reality. This evolution is noteworthy and results from the improved hospital information systems from which data
Conclusion
In this paper, we reviewed manuscripts on operating room planning and scheduling that have recently appeared. We analyzed the contributions on various levels, which we referred to as fields. Within each field, we highlighted the most important trends and we illustrated important concepts through the citation of key references. Since each discussion is accompanied by at least one detailed table, which provides even more information than is addressed in the text, readers may easily identify
Acknowledgements
We would like to thank the 3 reviewers for their constructive comments and their help in improving the paper. We acknowledge the support given to this project by the Fonds voor Wetenschappelijk Onderzoek – Vlaanderen (FWO – Vlaanderen) as Aspirant (Brecht Cardoen) and as Post-doctoral researcher (Jeroen Beliën).
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