Reducing Surgical Ward Congestion Through Improved Surgical Scheduling and Uncapacitated Simulation
Article first published online: 17 FEB 2011
© 2011 Production and Operations Management Society
Production and Operations Management
Volume 20, Issue 3, pages 418–430, May/June 2011
How to Cite
Chow, V. S., Puterman, M. L., Salehirad, N., Huang, W. and Atkins, D. (2011), Reducing Surgical Ward Congestion Through Improved Surgical Scheduling and Uncapacitated Simulation. Production and Operations Management, 20: 418–430. doi: 10.1111/j.1937-5956.2011.01226.x
- Issue published online: 13 MAY 2011
- Article first published online: 17 FEB 2011
- History: Received: November 2008; Accepted: May 2010, after 3 revisions.
- surgical scheduling;
- mixed integer programming;
- Monte Carlo simulation;
- scheduling guidelines;
- hospital bed management
High surgical bed occupancy levels often result in heightened staff stress, frequent surgical cancellations, and long surgical wait times. This congestion is in part attributable to surgical scheduling practices, which often focus on the efficient use of operating rooms but ignore resulting downstream bed utilization. This paper describes a transparent and portable approach to improve scheduling practices, which combines a Monte Carlo simulation model and a mixed integer programming (MIP) model. For a specified surgical schedule, the simulation samples from historical case records and predicts bed requirements assuming no resource constraints. The MIP model complements the simulation model by scheduling both surgeon blocks and patient types to reduce peak bed occupancies. Scheduling guidelines were developed from the optimized schedules to provide surgical planners with a simple and implementable alternative to the MIP model. This approach has been tested and delivered to planners in a health authority in British Columbia, Canada. The models have been used to propose new surgical schedules and to evaluate the impact of proposed system changes on ward congestion.