On the use of planning models in the operating theatre: results of a survey in Flanders

Enhancing Operating Room Efficiency: The Impact of Computational Algorithms on Surgical Scheduling and Team Dynamics

Background/Objectives: Operating room (OR) efficiency is a critical factor in healthcare delivery, influenced by various components including surgical duration, room turnover, staff availability, and equipment preparation. Optimizing surgical start times through systematic strategies such as computational algorithms can significantly enhance OR utilization and management. This study aimed to improve OR efficiency by effectively managing and optimizing surgical start times using a computational algorithm designed to allocate resources more efficiently. Methods: A comparative analysis was conducted over two six-month periods from January to June 2023 and January to June 2024, with an improvement phase implemented between July and December 2023. Results: These measures encompassed training surgical personnel, strengthening the medical team, revising work procedures and hospital regulations, and the integration of a computational algorithm to better schedule and manage surgical interventions. Following the implementation of these comprehensive measures, enhanced management of surgical start times was observed. A statistically significant increase in surgical interventions between 8 and 10 a.m. was noted for the entire OR, rising from 28.65% to 32.13%. While OR occupancy between 8 and 12 a.m. increased from 63.91% to 73.30%, this difference was not statistically significant. However, a notable improvement in average occupancy between 9 and 11 a.m. was observed, rising from 87.53% to 98.07%. Conclusions: The introduction of computational algorithms significantly improved operating room efficiency, particularly in managing surgical start times. Additionally, team coordination improved as a result of more structured scheduling processes. The results indicate that effective management of surgical start times, especially when enhanced by computational algorithms, can positively impact OR utilization, particularly within specific time blocks.

Prioritising patients for semi-urgent surgery: A scoping review

BACKGROUND

Semi-urgent surgery where surgical intervention is required within 48 h of admission and the patient is medically stable is vulnerable to scheduling delays. Given the challenges in accessing health care, there is a need for a detailed understanding of the factors that impact decisions on scheduling semi-urgent surgeries.

AIM

To identify and describe the organisational, departmental and contextual factors that determine healthcare professionals' prioritising patients for semi-urgent surgeries.

METHODS

We used the Joanna Briggs Institute guidance for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRISMA-ScR) checklist. Four online databases were used: EBSCO Academic Search Complete, EBSCO Cumulative Index to Nursing and Allied Health Literature, OVID Embase and EBSCO Medline. Articles were eligible for inclusion if they published in English and focussed on the scheduling of patients for surgery were included. Data were extracted by one author and checked by another and analysed descriptively. Findings were synthesises using the Patterns, Advances, Gaps, Evidence for practice and Research recommendations framework.

RESULTS

Twelve articles published between 1999 and 2022 were included. The Patterns, Advances, Gaps, Evidence for practice and Research recommendations framework highlighted themes of emergency surgery scheduling and its impact on operating room utilisation. Gaps in the management of operating room utilisation and the incorporation of semi-urgent surgeries into operating schedules were also identified. Finally, the lack of consensus on the definition of semi-urgent surgery and the parameters used to assign surgical acuity to patients was evident.

CONCLUSIONS

This scoping review identified patterns in the scheduling methods, and involvement of key decision makers. Yet there is limited evidence about how key decision makers reach consensus on prioritising patients for semi-urgent surgery and its impact on patient experience.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Strategic planning of operating room session allocation using stability analysis

Operating room (OR) resources are limited, and for this reason there is usually a competition among surgeons to win them. However, the methods developed for allocating OR sessions are mostly based on optimisation methods which compensate the preferences of surgeons or surgical specialities in favour of the productivity of the entire OR department. This leads to conflict and dissatisfaction among surgeons. To overcome this problem, a methodology based on game theoretic solutions is presented in this paper that formulates the allocation problem as a simple game. The surgeons or specialities as players then jointly pursue the goal of achieving overall stability. Stability is defined and measured using a method called Power Index. The proposed method is then combined with the Monte-Carlo technique to deal with uncertainties. To demonstrate the capability of the suggested procedures, they are applied to a case study from the literature and a set of hypothetical scenarios.

Tactical capacity planning in hospital departments

PURPOSE

The purpose of this paper is to explore tactical planning potential within hospital departments. The study had two objectives: first, to develop a framework for tactical capacity planning in healthcare departments by identifying and structuring essential components for healthcare capacity management; and, second, to identify context-specific requirements and functionality demands on tactical planning processes within healthcare.

DESIGN/METHODOLOGY/APPROACH

A framework for tactical capacity planning was developed through a literature review. Additionally, an exploratory multiple-case study was performed, with cases from three Swedish hospital departments, which provide the opportunity to study framework applicability in its natural context.

FINDINGS

Findings illustrate how an active tactical planning process can facilitate adjustments to capacity. However, the multiple-case study shows that there are contextual differences between departments, depending on available treatments and resources that affect capacity adjustments, and how the planning process activities should be structured.

ORIGINALITY/VALUE

This project develops a framework for a tactical capacity-planning process adapted to healthcare provider contexts. By developing the framework, based on the literature and tactical level planning processes within three Swedish hospital case studies, the authors bridge gaps between theory and application regarding healthcare capacity planning.

Operational antecedents of integrated patient planning in hospitals

Purpose

– Hospitals struggle to integrate the planning from different departments; resulting in unacceptable waiting times for patients. The literature mainly addresses general, organizational factors inhibiting or enabling integration and omits important factors stemming from the care delivery process. Therefore, the purpose of this paper is to uncover operational antecedents and to assess their effect on the integration of hospital planning.

Design/methodology/approach

– The study is based on a three-hospital multi-case study. The main findings stem from over 40 in-depth interviews with specialists, nurses, planners, and managers of four specialties that are all involved in the orthopedic internal supply chain.

Findings

– This study identifies five critical operational antecedents: performance management, shared resources, information technology, process visibility, and uncertainty/variability. The latter two are of specific importance in a healthcare context. Three distinctive roles are identified; initiating (performance management and process visibility), facilitating (information technology), and inhibiting (shared resources and uncertainty/variability).

Practical implications

– The authors address how integration can be achieved, rather than merely prescribing integration as a means to improve performance. The identification of specific operational antecedents and their role help managers to find tangible ways to effectively integrate hospital planning which increases hospital performance.

Originality/value

– First, the identified operational antecedents are essential supplementary factors to more common organizational and behavioral antecedents. Second, in contrast to earlier contributions the authors show the effects of antecedents on three different stages of integration, rather than on integration in general.