Day surgery appointment scheduling with patient preferences and stochastic operation duration.

Operating Room (OR) is the core sector in hospital expenditure, the operation management of which involves a complete three-stage surgery flow, multiple resources, prioritization of the various surgeries, and several real-life OR constraints. As such reasonable surgery scheduling is crucial to OR management. To optimize OR management and reduce operation cost, a short-term surgery scheduling problem is proposed and defined based on the survey of the OR operation in a typical hospital in China. The comprehensive operation cost is clearly defined considering both under-utilization and overutilization. A nested Ant Colony Optimization (nested-ACO) incorporated with several real-life OR constraints is proposed to solve such a combinatorial optimization problem. The 10-day manual surgery schedules from a hospital in China are compared with the optimized schedules solved by the nested-ACO. Comparison results show the advantage using the nested-ACO in several measurements: OR-related time, nurse-related time, variation in resources' working time, and the end time. The nested-ACO considering real-life operation constraints such as the difference between first and following case, surgeries priority, and fixed nurses in pre/post-operative stage is proposed to solve the surgery scheduling optimization problem. The results clearly show the benefit of using the nested-ACO in enhancing the OR management efficiency and minimizing the comprehensive overall operation cost.

MP68-19 USE OF THE OR BLACK BOX® TO EVALUATE OPERATING ROOM ECONOMIC EFFICIENCY

An integrated approach for surgery scheduling under uncertainty

Because most anesthesiologists work in the operating room setting, anesthesiologists are involved with the management of the operating room suite (or “theater”). Even if they are not responsible for the management, anesthesiologists still want to understand the decision-making process and metrics that affect their daily schedule and duties. In the United States, anesthesiologists can attend in-person conferences and seminars on leadership, practice management, and operating room management offered by national associations, online webinars and resources, and textbooks. Although these offerings will give anesthesiologists groundwork for calculations of metrics, e.g., productivity and efficiency, an in-depth discussion is not done.In contrast, Practical Operating Theater Management: Measuring and Improving Performance and Patient Experience provides the reader in-depth materials on data-driven metrics, including operating room efficiency, productivity, utilization, and scheduling. The book purposely is designed not to cover leadership or management styles but focuses on collecting and employing operating room data in a manner that is practical and applicable.The book has two functional sections. The first includes an introduction and eight chapters that cover the terms and principal content, as well as efficiency, productivity, scheduling, planning, staffing and contracts, operating room finances, and preoperative patient preparation. The second section contains five chapters examining operating room management in different countries, including Japan, The Netherlands, Switzerland, Australia, and the United States. Chapter 14 then covers operating room safety, and chapter 15 (the last) provides an overview of the book by a contributor.Some of the topics discussed include the different formats used to manage surgical block times, as well the importance of normalizing terms and definitions so the collected data can be reported, analyzed, and acted upon effectively. Among the data that proves useful to collect is operating room capacity, demand by surgeons, utilization rate, overruns, cancellation rate, start times, and turnover times, with some of these bundled into key performance indicators. Of these, efficiency (as defined in chapter 2), on-time start, and turnover times are considered fundamental.Chapter 2 is central to the book, and in it the author cautions that the much-used and maligned measurement of on-time starts or cancellation rates by themselves are a poor measure of overall operating room efficiency. Efficiency as a measurement is clearly defined in a mathematical formula, and the manner in which operating room management decisions affect it is discussed in detail. Subsequent chapters cover measures of productivity (chapter 3) and strategies for scheduling (chapter 4), with an emphasis on maintaining and utilizing a real-time database of facility-specific surgical times, capacity planning of schedules, and add-on operating room capacity (chapter 5). Operating room staff contracts and the prominent role of staffing in providing the capacity is covered in chapter 6. Chapters 7 and 8 cover operating room finances and preoperative patient preparation, respectively.Although the book’s editor and major contributors are from the United Kingdom, the concepts are applicable to operating room management in the United States as well as other countries. In fact, the latter half of the book explores the similarities and differences in operating room management in different countries, including New Zealand, Japan, The Netherlands, Switzerland, and the United States. It is amazing that anesthesiologists from many different countries face similar challenges.For data-driven metrics, it is not surprising that the book relies on a mathematical approach to data. This math-heavy approach would be more appealing to business-trained operating room managers rather than physicians, although the author did attempt to make it more accessible by incorporating these formulas into Excel spreadsheets. We believe anyone interested in implementing data-driven decision-making processes will be able to follow the mathematical progression that occurs in the first half of the book.Overall, this book is a useful resource to anesthesiologists, operating room managers, and financial analysts on the topics of data-driven metrics. It provides a unique educational resource for those who are new to the topic of operating room efficiency, utilization, and productivity. For those who have been working with these concepts, the book provides a resource to reexamine our formulas with an international perspective.

Many surgical suites allocate operating room (OR) block time to individual surgeons. If block time is allocated to services/groups and yet the same surgeon invariably operates on the same weekday, for all practical purposes block time is being allocated to individual surgeons. Organizational conflict occurs when a surgeon with a relatively low OR utilization has his or her allocated block time reduced. The authors studied potential limitations affecting whether a facility can accurately estimate the average block time utilizations of individual surgeons performing low volumes of cases. Discrete-event computer simulation. Neither 3 months nor 1 yr of historical data were enough to be able to identify surgeons who had persistently low average OR utilizations. For example, with 3 months of data, the widths of the 95% CIs for average OR utilization exceeded 10% for surgeons who had average raw utilizations of 83% or less. If during a 3-month period a surgeon's measured adjusted utilization is 65%, there is a 95% chance that the surgeon's average adjusted utilization is as low as 38% or as high as 83%. If two surgeons have measured adjusted utilizations of 65% and 80%, respectively, there is a 16% chance that they have the same average adjusted utilization. Average OR utilization can be estimated more precisely for surgeons performing more cases each week. Average OR utilization probably cannot be estimated precisely for low-volume surgeons based on 3 months or 1 yr of historical OR utilization data. The authors recommend that at surgical suites trying to allocate OR time to individual low-volume surgeons, OR allocations be based on criteria other than only OR utilization (e.g., based on OR efficiency).

Scheduling elective surgeries is a dynamic, sequential decision-making process that must balance the costs of deferring waiting cases and blocking higher-priority cases. Although other surgery scheduling problems have received extensive treatment in the literature, this paper presents the first single-day scheduling problem formulation to capture this aspect of the scheduling process while also incorporating surgical block schedules, block release policies, and waiting lists. Theoretical results for the special case in which all cases have the same duration motivate a range of threshold-based heuristics for the general problem with multiple case durations. Our computational results demonstrate the effectiveness of the proposed heuristics and show how block release dates affect the quality of the scheduling decisions. Based on these results, we propose a new approach to surgery scheduling. In particular, to make more equitable waiting list decisions, operating room (OR) managers should gradually release unused OR time over the course of several days leading up to the day of surgery.

Objective:This study examines the 2009 patient operating room (OR) length of stay data for a medical center in Taipei City. Using a statistical method based on regression analysis, the crucial factors that influence OR efficiency and performance were identified. The analytical results indicated that surgical procedures with general anesthesia and high surgical complexity incurred high surgical fees. Additionally, the anesthesia fees, operating time, and operating time variance rises as the squared number of surgical procedures increases. Therefore, for the hospitals 2010 OR scheduling management strategy, we adjusted the priority regulations for daily OR use to enhance the safety and quality of surgical patient health care and improve OR efficiency.Method:We collected 11 case ORs, that is, 9 inpatient and 2 outpatient ORs, for this study. The pre-implementation data were collected between January 1, 2009, and December 31, 2009. The post-implementation data were collected between January 1, 2010, and December 31, 2010; both forms of data included patients OR length of stay information. Furthermore, the indicators that were compared and analyzed for this study included variances in the number of cases in which general anesthesia was administered, the number of scheduled surgical procedures, the number of emergency surgical procedures, and OR use rates.Results:A total of 20,731 surgical operations were performed in 2009, among which general anesthesia was administered 6,925 times, 10,122 scheduled surgical procedures were performed, 1,305 emergency surgical procedures were performed, and the OR use rate was 70.30%. A total of 21,105 surgical operations were performed in 2010, among which general anesthesia was administered 7,106 times, 10,549 scheduled surgical procedures were performed, 1,319 emergency surgical procedures were performed, and the OR use rate was 71.05%.

Operating Room Leadership and Perioperative Practice Management is a revised second-edition textbook, intended to be an up-to-date resource for all aspects of operating room management. This edition has 11 new chapters and there has been a substantial revision to the 27 chapters that were retained from the first edition. The book is organized into 5 sections: (1) leadership and strategy; (2) economic considerations, efficiency, and design; (3) surgical and anesthesia practice management; (4) nursing; and (5) safety, standards, and information technology. The contributors to the book are experts in their fields and the majority of the 71 authors are department chairs, medical center chief executive officers, executive directors, or directors of coding or compliance. One of the strengths of this book is the clarity of writing. Each chapter is approximately 10–15 pages in length. The chapters deconstruct complex topics, provide clear definitions for commonly used terms, and, most importantly, provide concrete anesthesia-specific examples. Figures and tables supplement almost every chapter and highlight key learning points. The section on leadership and strategy is perhaps one of the best-written sections of the book, as many of the principles commonly used in the business world are not familiar to many practicing anesthesiologists, yet the reader is given a sufficient primer to have a functional understanding of the relevant tenets. The chapter on The Joint Commission, Center for Medicare and Medicaid Services, and other standards, in particular, is an excellent summary of the history of the modern health care system and the evolution of standards and accreditation over the past century. As the legislative landscape has changed significantly in a relatively short period of time, the authors provide a concise summary of key concepts affecting all anesthesiologists. Another strength of the book is the comprehensive discussion of all aspects of operating room management, from conception of operating room design to staffing and personnel relationships. The authors recognize that the operating room environment is complicated, with its own culture. Successful leaders must understand this complex environment and work collaboratively to effectively manage the operating room. While this overview works well for most chapters, some of the chapters do seem slightly superficial, in particular Chapters 5 (Implications of Emotional Intelligence and Collaboration for Operating Room Leadership and Management), 16 (Efficiency and Scheduling), and 27 (Operating Room Metrics). These chapters have a cursory discussion of 3 very complex topics, leave the reader wanting more information, and do not give the reader the necessary tools to act on the information presented. This might limit the usefulness of the book for someone without existing leadership experience. A further limitation is that the book is intended for use by a multidisciplinary audience, thus some of the information presented, particularly in the preoperative evaluation and management chapter, may seem basic to the established anesthesiologist. Finally, the title of Section 4, “Nursing,” is a bit misleading. While all 3 chapters in this section have nursing implications, the section delves into broader topics, such as staffing and throughput, which are relevant to a broader audience. Ultimately, successful operating room management involves not only administrative efficiency but also knowledge of the legislative landscape and development of high-performing teams who deliver patient care. This book is an excellent primer for physician anesthesiologists who would like to ascend to perioperative leadership roles. While the contents of this book are likely to be a review for experts or established leaders, it is useful for resident trainees, those stepping into leadership positions, or even anesthesiologists who are not in leadership but who would like to better understand the mechanics of operating room management. Nicole Higgins, MDDepartment of AnesthesiologyNorthwestern University Feinberg School of MedicineChicago, IllinoisPaloma Toledo, MD, MPHDepartment of AnesthesiologyNorthwestern University Feinberg School of MedicineChicago, IllinoisCenter for Healthcare StudiesNorthwestern University Feinberg School of MedicineChicago, Illinois[email protected]

Short-notice cancellations of laparoscopic permanent contraception

Enhancement opportunities in operating room utilization; with a statistical appendix

Effective leadership is critical to ensuring safety, efficiency and maximum productivity in the operating room (OR). This practical, evidence-based book unpicks the dynamics of a successful OR environment to underline the key techniques for management of policies, systems, staff members and teams. Fully updated to include recent clinical guidelines, the book provides the 'A-Z' of OR management, including sections on metrics, scheduling, human resource management, leadership principles, economics, quality assurance, recovery and ambulatory practice. New chapters include future healthcare models, emergency preparedness and budgets amongst other topics. Written by authors with unrivalled experience in the field, chapters are laid out in an easy and clinically helpful format to assist learning, and real-life case studies cover 73 different clinically relevant pain topics. This book is an essential guide for anyone working in the OR including anaesthesiologists, surgeons, nurses, and administrators.

Patient admission and surgery scheduling is a complex combinatorial optimization problem. It consists on defining patient admission dates, assigning them to suitable rooms, and schedule surgeries accordingly to an existing master surgical schedule. This problem belongs to the class of NP-hard problems. In this paper, we firstly formulate an integer programming model for offline patient admissions, room assignments, and surgery scheduling; then apply a matheuristic that combines exact methods with rescheduling approaches. The matheuristic is evaluated using benchmark datasets. The experimental results improve those reported in the literature and show that the proposed method outperforms existing techniques of the state-of-the-arts.

Resuming elective surgery after COVID-19: A simulation modelling framework for guiding the phased opening of operating rooms

Operating room (OR) scheduling is a critical challenge in healthcare, directly impacting patient outcomes and hospital efficiency. Traditional methods often struggle with the complex, multi-level constraints and uncertainties inherent in OR scheduling, such as resource limitations, variable surgery durations, and emergency cases. This study aims to develop a novel hybrid framework that optimizes OR scheduling by integrating multi-level optimization with reinforcement learning and column generation techniques. The proposed framework decomposes the OR scheduling problem into strategic, tactical, and operational levels, enabling focused optimization at each layer while ensuring cohesive decision-making across the hierarchy. Reinforcement learning guides the column generation process, learning policies that identify promising scheduling options to enhance solution quality and computational efficiency. Robust uncertainty handling mechanisms are incorporated to manage variability in surgery durations and resource availability without compromising tractability. Experiments were conducted using three years of real-world data from Shanxi Provincial People's Hospital, complemented by large-scale synthetic datasets to evaluate scalability and robustness of the framework. The framework demonstrates meaningful improvements in key operational metrics compared to traditional approaches. Analysis of three years of implementation shows consistent enhancements in operational efficiency, including a reduction in average patient waiting time by 15.8% (from 10.1 to 8.5 days), an increase in OR utilization by 5.4 percentage points (from 73.8% to 79.2%), and improved workload balance among surgeons. The framework maintains robust performance under uncertainty, achieving a 92.5% feasibility rate and reducing schedule disruptions by 26.2%. The proposed hybrid framework offers a practical and scalable solution for optimizing OR scheduling, demonstrating improvements in healthcare delivery and operational performance in real hospital environments. By effectively balancing multiple operational objectives while handling practical constraints and uncertainties, the framework provides a viable approach for healthcare systems seeking incremental yet sustainable improvements in efficiency and patient care.

The operating room is a vital service in hospitals. The quality of service from theoperating room can be assessed from one indicator, namely operating room utilization.Utilization is the actual time required to carry out additional operations turnover (operationtransfer time) divided by the available time, where turnover averages over 15 minutes.Estimation of the duration of surgery is an important factor in operating room utilization.The aim of this study was to determine the relationship between the accuracy of estimatingthe duration of surgery and the utilization of elective operating rooms in the Central SurgeryInstallation at RSUD Dr. Saiful Anwar Malang. This research method is a prospective cohortfor 19 working days. The sampling technique uses total sampling. The results of the studywere that almost all 284 operations (93.4%) were accurate in estimating the duration of theoperation according to estimates, and the majority of 197 operating rooms (64.8%) hadoperating room utilization in the poor category. Data analysis uses Chi-Square which showsthat the p-value is 0.007 <0.05, which means there is a relationship between the estimatedduration of surgery and operating room utilization. Operating room utilization can beoptimal if one of the factors can be met, namely the operation can be completed on time (onTime) which means the estimation of the duration of the operation must also be correct.Therefore, there is a need for synergy between multidisciplines in the operating room andmanagement in setting schedules and standards for estimating the duration of operations andit is necessary to re-socialize the quality of the operating room for users of the operatingroom and the rooms involved in it, because part of the quality of the operating room is afactors that can influence operating room utilization.