Upload
prashanth-natarajan-iyer
View
224
Download
0
Embed Size (px)
Citation preview
8/2/2019 Operating Room Scheduling
1/20
An Approach for Scheduling the Operating Rooms of a Hospital
Islam Ali, Prashanth Natarajan, Harshit Sodhani and Amina Lyazidi
IE 632 Scheduling Models
Dr. Seokcheon Lee
April 20, 2012
8/2/2019 Operating Room Scheduling
2/20
2
Table of Contents
ABSTRACT 3
INTRODUCTION 4
PROBLEM DEFINITION 5
BACKGROUND 7
LITERATURE REVIEW 7
SIGNIFICANCE 9
SOLUTION APPROACH 10
MODEL CHARACTERISTICS 10
MAIN ARENA MODEL 10
PROCESS DESCRIPTION 12
ARENA ARRIVAL PROCESS 12
ARENA QUEUING AND SCHEDULING PROCESS 13
ARENA ORPROCESS 14
ARENA RECORDING AND DISPOSAL PROCESS 14
EVALUATION 16
BENCHMARK ERROR!BOOKMARK NOT DEFINED.
CONCLUSION 19
REFERENCES 20
8/2/2019 Operating Room Scheduling
3/20
3
Abstract
We hear about health care issues in the US a lot in the news, and as many issues there are, there are a
tenfold more solution proposals that would or would not solve these issues or at least alleviate their
impact. One central issue of health care is its exceedingly high costs that limit the access of healthcare
services to the population that can afford these costs or have a proper insurance coverage.
One way to address these issues is to effectively manage the Operating Rooms (OR) as they are the
most costly and yet the most lucrative units in a hospital. We chose the scheduling model of Arnaout
and Kulbashian 2008, which configured a parallel machine environment with stochastic processing times
and sequence dependent setup times. The objective was to minimize the makespan, which infers
maximizing the utilization of the operating rooms. Using Arena as scheduling and benchmarking tool,
LEPST (Longest Expected Processing with Setup Time) was shown to yield the optimal scheduling
alternative.
As an expansion to their work, we developed the same model taking into consideration dynamic
scheduling, that accounts for operations arriving over time as it reorder the scheduled operations
whenever a new one arrives. We also used Arena simulation tool to compare between the heuristics
and to get the heuristic that yields the best results.
8/2/2019 Operating Room Scheduling
4/20
4
Introduction
Operating rooms are known to be the sink of many expenses. Indeed, operating rooms are the
most costly units in hospitals as they require for their maintenance and operation many resources from
equipment, time and personnel. They also represent the highest revenue pool of hospitals due to the
high costs of surgeries and service fees that US health care is known for. The operating rooms in fact
represent more than 40% of a hospitals total revenues and the same amount in terms of the total
expenses (Peltokorpi, 2011, p. 370). These characteristics render the operating rooms a strong driver of
the performance of any hospital.
Thus, it is of primal importance to well manage the OR, however, this task is not without
challenges that stem from conflicting priorities of different staff (physicians, nurses, and the hospital
management staff) and also from the lack of the resources the OR needs. The challenge is increased if
we took into consideration the aging of the population that makes this latter more needful of OR
services. (Cardoen, B., Demeulemeester, E., Belin).
In order to account for all these, a rigorous scheduling should be put into practice that is tailored
to the specific hospital at hand and that would take care of all the constraints and challenges. Such
schedule would be compared to other alternatives in order to ascertain the use of an optimal schedule,
insuring the highest possible productivity of the operating rooms with the least consumption of
resources. This would tremendously increase the revenues of the hospital and decrease its expenses.
8/2/2019 Operating Room Scheduling
5/20
5
Problem Definition
We are concerned with finding an optimal schedule for elective surgery cases for a hospital.
As the term elective surgery may induce to confusion , we give hereby a short definition of an elective
surgery:
An elective surgery is a planned, non-emergency surgical procedure. It may be either medically
required (e.g., cataract surgery), or optional (e.g., breast augmentation or implant) surgery.
(In Encyclopedia of Surgery, 2012)
We are considering a hospital with 4 operating rooms and 5 different major types of operations
are allotted to these operating rooms. Each of these major surgery types has a different stochastic
duration, along with a preparation phase before the actual surgery is conducted. The length of this
preparation phase changes according to which type of operation is scheduled before the currently
scheduled surgery.
Therefore, this problem, converted into job scheduling, is equivalent to a parallel machine
model with stochastic processing times, with as constraints, sequence dependent setup times, and with
as objective, minimizing the total completion time.
We will be also taking into consideration that surgeries will be arriving over time, having a
release date, a feature in the model that could also be used for dynamic scheduling and which is an
expansion of the work done by Arnaout, J-P. M., and Kulbashian S., 2008.
8/2/2019 Operating Room Scheduling
6/20
6
Thus, our OR scheduling problem is as follows:
The operating rooms are the machines. The selective surgeries are the jobs. The surgeries can be done in any OR (machine). Operations have a release date. The objective is to find a schedule for the surgeries by minimizing:
This problem is known to be an NP-hard problem, and thus, an appropriate heuristic will be
devised for solving it.
8/2/2019 Operating Room Scheduling
7/20
7
Background
Literature Review
Arnaout and Kulbashian 2008, addressed the problem of scheduling selective surgeries in the
operating rooms of a Lebanese hospital. They configured the problem as a parallel machine scheduling
problem with stochastic processing times for the jobs and with sequence dependent setup times. They
chose as an objective the minimization of the makespan, which translates to maximizing the utilization
of the operating rooms. Since this problem is NP-hard, the authors proposed three main heuristic s: LPT
(Longest Processing Time First) and SPT (Shortest Processing Time First), LEPT (Longest Expected
Processing First) and SEPT (Shortest Expected Processing Time First), and LEPST (Longest Expected
Processing with Setup Time). The authors compared and verified the last two main heuristics using
ARENA simulation tool, which showed that the most effective heuristic algorithm is LEPST. The authors
ended up by suggesting considering dynamic scheduling as an extension to their work.
Cardoen, Demeulemeester, and Belin have surveyed and collected papers that presented the
latest breakthroughs on OR planning and scheduling and classified them according to the specific field
from which they tackle the scheduling of OR.
The authors identified seven fields in which they organized their taxonomy. These fields are as follows:
Patient Characteristics, performance measures, decision level, type of analysis, solution technique,
uncertainty, and applicability of research.
The authors suggested as future work, to reduce the number of fields and to compile the data without
causing the loss of any of it during this process of reduction. The reason behind these potential
reduction efforts is to generate a more transparent and simple classification scheme.
8/2/2019 Operating Room Scheduling
8/20
8
Dexter, Macario, and Traub, 1999 had as an objective to find an optimal algorithm for
scheduling add-on elective cases that would maximize the utilization of OR. They used
computer simulation to evaluate 10 scheduling algorithms, such as on-line and off-line
algorithms in terms of their performance at scheduling on on-going number of add-on elective
surgeries. They collected data about 2 OR suites about their relative hours of open OR time
reserved daily for add-on cases and the duration of each surgical case. The optimal algorithm
found was the Best Fit Descending with fuzzy constraints.
Serhat, Denton , Fowler, and Huschka, 2011 were comparing a number of 12 heuristic
algorithms that would schedule the operating rooms in an Outpatient Procedure Center. Those
algorithms would put an end to the issues of the uncertainty of the duration of surgeries that
has a bad effect on the patients waiting time, the utilization of resources and the overtime
costs. The researchers based their study in an OPC at Mayo Clinic, in Rochester, Minnesota,
where an OPC being a complex system with various surgical groups. They first built a simulation
model that evaluated the different heuristics. Next they embedded this simulation model to a
hybrid solution method that included a genetic algorithm and appointment heuristics. This
hybrid method was used to construct a near Pareto optimal set of schedules. They propose as
a future research to investigate other more complicated scheduling techniques that would take
into consideration additional resource types that have not been considered in this paper and
evaluate their effect.
8/2/2019 Operating Room Scheduling
9/20
9
Significance
The surgical operating rooms are, as previously stated, the most resource and money-draining
units in hospitals, and even in the whole health service production (Peltokorpi, 2011, p. 370). Peltokorpi,
2011, has devoted a research study on the effect that operative management decisions have on the
productivity of operating rooms.
The researcher identified 11 hypotheses that identify a sort of link between the use of analytical
decisions in regards to operating rooms and the productivity of these latter. One of these hypotheses
was: Operating units with a narrow service scope have higher productivity than units providing a wide
range of services (Peltokorpi, 2011, p. 370). This research was conducted in a 26 multi-hospital units in
15 hospitals. 24 units were located in Finland, one in Germany and one in the US.
The results of this study showed that the most influential decisions of productivity are personal
management, case scheduling and performance measurement, whereas strategic decisions that relate,
for instance, to the size of the surgical units, the scope or academic status have a more marginal
influence on the productivity of operating rooms.
Consequently, we see that the practice of organizing schedules to operating rooms is highly
important as it significantly influences their productivity, and so, significantly influences the productivity
of the whole hospital.
This study also showed that the sort of operative practices that surgical units should use depend
on the strategic positions of these units. In other words, the hospital units that are focused need
sophisticated case scheduling, but flexible hours, incentives and multi-skilled hospital staff are more
adequate to hospital units that are central and ambulatory. Thus, not only scheduling ORs is important,
but also tailoring the scheduling to the type of these units is important for a better productivity of the
OR.
8/2/2019 Operating Room Scheduling
10/20
10
Solution Approach
Model Characteristics
In order to study the operating of the hospital, a model was created on Arena to get a clear
picture of the allocation of the patients to the operating rooms that were free at the time of arrival.
Main Arena Model
Arrival Pr
The model is described as below:
The model considers patients who come to the hospital, must undergo one of five types of
operating procedures. All the operating rooms in the hospital are equipped to carry out any of the five
operations (with a setup time in between). The time gap between the arrivals of patients is considered
to be exponentially distributed.
2C r e a t e t y p e
Dis p o s e 1
1P r o c es s O R
2P r o c es s O R
3P r o c es s O RP r o c e s s O R 1 . W I P = = 0
P r o c e s s O R 2 . W I P = = 0P r o c e s s O R 3 . W I P = = 0P r o c e s s O R 4 . W I P = = 0El s e
D e c ide 1
4P r o c es s O R
Dis p o s e 2
Se ize 1
Re le a s e 1
A s s ign 1
3C r e a t e t y p e
A s s ign 2
4C r e a t e t y p e
A s s ign 3
A s s ign 5
R e c o r d 1
T r u e
F a ls e
a t t r ib u t e b y p a s sU p d a t in g e n t it y
De lay 1 A s s ign 6
Re le a s e 2
A s s ign 7
De lay 2
5C r e a t e t y p e
A s s ign 8
1C r e a t e t y p e
A s s ig n 1 5
A s s ig n 1 6
A s s ig n 1 7
A s s ig n 1 8
A s s ig n 1 9
E n t it y . T y p e = = t y p e 1
E n t it y . T y p e = = t y p e 2E n t it y . T y p e = = t y p e 3
E n t it y . T y p e = = t y p e 4E n t it y . T y p e = = t y p e 5
El s e
D e c ide 3
Dis p o s e 3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
OR
ProcessQueuing and Scheduling
Process
Arrival Process Recording and
Disposal Process
8/2/2019 Operating Room Scheduling
11/20
11
Each operation has its own processing time assigned as given below:
Operation Type Processing Time (In Hours)
1UNIF(1.2, 1.5)
2 UNIF (2.2, 2,3)
3 UNIF (6.5, 6.9)
4 UNIF (6.8,7.2)
5 UNIF(7.5,8.1)
Also, there is a setup time between operations in the operating room. This is the time required
to prepare the room for the operation. This might involve cleaning the room, arranging the operating
instruments and so on. The setup times are not constant for the different pair types of operations, i.e.
the setup time between operations depends on the operation that has just been completed and the
operation that is to be done.
8/2/2019 Operating Room Scheduling
12/20
12
Process Description
Arena Arrival Process
As the patients enter the hospital, they must enter a queue until they are allocated a free
operating room. The patient released is the one with the lowest attribute value (which will be described
shortly). The queue is achieved with the help of a Seize module.
Create type 2 Assign 1
Create type 3 Assign 2
Create type 4 Assign 3
Create type 5 Assign 8
Create type 1 Assign 15
0
0
0
0
0
8/2/2019 Operating Room Scheduling
13/20
13
Arena Queuing and Scheduling Process
When a patient enters the Seize module, he/she is sent to the Operat ing Room which is free.
Whether an operating room is free or not is communicated to the Seize module with the help of an
allocated resource carrying a value of either 1 (Busy) or 0 (Free).
P r o c e s s O R 1 .W I P = = 0
P r o c e s s O R 2 .W I P = = 0
P r o c e s s O R 3 .W I P = = 0
P r o c e s s O R 4 .W I P = = 0E l s e
Decide 1
Dispose 2
Seize 1
T r u e
F a l s e
bypassUpdating entity attribute
Release 2
Assign 7
Delay 2
Assign 16
Assign 17
Assign 18
Assign 19
E n t it y . Ty p e = = t y p e 1
E n t it y . Ty p e = = t y p e 2
E n t it y . Ty p e = = t y p e 3
E n t it y . Ty p e = = t y p e 4
E n t it y . Ty p e = = t y p e 5
E l s e
Decide 3
Dispose 3
0
0
0
0
8/2/2019 Operating Room Scheduling
14/20
14
Arena OR Process
In these four blocks, the selected cases/patients undergo their operations.
Arena Recording and Disposal Process
When a patient leaves the operating room, the count is recorded and the type of patient leaving
is recorded. This is used to update the setup time as follows:
Process OR 1
Process OR 2
Process OR 3
Process OR 4
0
0
0
0
DisposeRelease 1
Assign 5
Record 1Delay 1 Assign 6
8/2/2019 Operating Room Scheduling
15/20
15
If patient of type 1 exits the operating room, an additional amount of set-up time is added to
the processing time of the patients in the queue. There is a setup time defined for each pair of patient
types. Continuing with the example, when patient 1 exits the operating room, a setup time S12 is added
to patient 2, S13 is added to patient type 3 and so on until patient of type 5. If patient of type 2 was to
exit from the operating room then a setup time of S23 would be added to patient type 3 and so on.
This is important as the additional setup time is used to record the attribute which is used to
decide which patient has to go into the next free operating room.
Patients are disposed of after their operation is completed. As the patient leaves, a Record
module registers his/her operations setup time to be used for the ORs setup time of the next patient.
The existent patient triggers the release module which lets one patient to enter the now free operating
room following the queuing principle as explained above. Also a var iable called Bypass Variable is set to
one. This variable is used to decide whether the entity (patient) must enter the operating room or must
go through the updating of the processing times and wait back in the queue module.
8/2/2019 Operating Room Scheduling
16/20
16
EvaluationAfter implementing our suggested solution procedure for the studied scheduling problem using Arena
simulation software, we experimented with different approaches for ordering schedulable jobs
(patients) waiting to be processed (operated). Three queue disciplines were tested in this stage;
FIFO (First in first out) LEPST (Longest Expected Processing with Setup Time) SEPST (Shortest Expected Processing with Setup Time)
In order to assess the performance of the three approaches, we implemented all of them as different
scenarios in our simulation model and compared the expected waiting time for the different types of
patients by conducting ANOVA analysis.
Figure 1: Total time for type 1 patients across all three scenarios
8/2/2019 Operating Room Scheduling
17/20
17
Figure 2 : Total time for type 3 patients across all three scenarios
8/2/2019 Operating Room Scheduling
18/20
18
Figure 3: Total time for type 5 patients across all three scenarios
8/2/2019 Operating Room Scheduling
19/20
19
Conclusion
We have identified the operating rooms unit as field of study and research that would address
many issues that health care is facing, since it is one of the important unit in a hospital, cost and
resource-wise. We also showed in the significance part of this paper that tackling the productivity of
operating rooms and controlling it by an appropriate scheduling model has a high importance and return
to the hospital. We chose to expand on the research done by Arnaout and Kulbashian 2008, by taking
the same parallel machine environment with the same constraints of stochastic processing times and
case-related set-up times and expanding them into an on-line heuristic scheduling algorithm that
updates its scheduling plan whenever a new operation comes up.
Our own study would be further developed and expanded if it takes into consideration the non-
terminating simulation that characterizes emergency rooms and including within the scheduling of
normal operating room units.
8/2/2019 Operating Room Scheduling
20/20
20
References
Arnaout, J-P. M., and Kulbashian S. (2008). Proceedings from Winter Simulation Conference 08:
Maximizing the Utilization of Operating Rooms with Stochastic Times Using Simulation.
S. J. Mason, R. R. Hill, L. Mnch, O. Rose, T. Jefferson, J. W. Fowler eds.
Cardoen, B., Demeulemeester, E., Belin, J. Operating room planning and scheduling: A
literature review. Retrived from
https://lirias.kuleuven.be/bitstream/123456789/165923/1/KBI_0807.pdf
Dexter, F., Macario, A., Traub, R. D. (1999). Which Algorithm for Scheduling Add-on Elective
Cases Maximizes Operating Room Utilization? Anesthesiology, 91, 1491-1500.
Elective surgery. (2012). In Encyclopedia of Surgery. Retrieved from
http://www.surgeryencyclopedia.com/Ce-Fi/Elective-Surgery.html
Peltokorpi, A. (2011). How do strategic decisions and operative practices affect operating room
productivity. Health Care Management Science, 14, 370-382.
Serhat, G., Denton, B. T., Fowler, J. W., Huschka, T. (2011). Bi-criteria Scheduling of Surgical
Services for an Outpatient Procedure Center. Production and Operations Management,
20, 406-417.
https://lirias.kuleuven.be/bitstream/123456789/165923/1/KBI_0807.pdfhttps://lirias.kuleuven.be/bitstream/123456789/165923/1/KBI_0807.pdfhttp://www.surgeryencyclopedia.com/Ce-Fi/Elective-Surgery.htmlhttp://www.surgeryencyclopedia.com/Ce-Fi/Elective-Surgery.htmlhttp://www.surgeryencyclopedia.com/Ce-Fi/Elective-Surgery.htmlhttps://lirias.kuleuven.be/bitstream/123456789/165923/1/KBI_0807.pdf