Publications (11)15.17 Total impact
-
Article: A simulation model for determining the optimal size of emergency teams on call in the operating room at night.
[show abstract] [hide abstract]
ABSTRACT: Hospitals that perform emergency surgery during the night (e.g., from 11:00 pm to 7:30 am) face decisions on optimal operating room (OR) staffing. Emergency patients need to be operated on within a predefined safety window to decrease morbidity and improve their chances of full recovery. We developed a process to determine the optimal OR team composition during the night, such that staffing costs are minimized, while providing adequate resources to start surgery within the safety interval. A discrete event simulation in combination with modeling of safety intervals was applied. Emergency surgery was allowed to be postponed safely. The model was tested using data from the main OR of Erasmus University Medical Center (Erasmus MC). Two outcome measures were calculated: violation of safety intervals and frequency with which OR and anesthesia nurses were called in from home. We used the following input data from Erasmus MC to estimate distributions of all relevant parameters in our model: arrival times of emergency patients, durations of surgical cases, length of stay in the postanesthesia care unit, and transportation times. In addition, surgeons and OR staff of Erasmus MC specified safety intervals. Reducing in-house team members from 9 to 5 increased the fraction of patients treated too late by 2.5% as compared to the baseline scenario. Substantially more OR and anesthesia nurses were called in from home when needed. The use of safety intervals benefits OR management during nights. Modeling of safety intervals substantially influences the number of emergency patients treated on time. Our case study showed that by modeling safety intervals and applying computer simulation, an OR can reduce its staff on call without jeopardizing patient safety.Anesthesia and analgesia 12/2008; 107(5):1655-62. · 3.08 Impact Factor -
Article: Fewer intensive care unit refusals and a higher capacity utilization by using a cyclic surgical case schedule.
[show abstract] [hide abstract]
ABSTRACT: Mounting health care costs force hospital managers to maximize utilization of scarce resources and simultaneously improve access to hospital services. This article assesses the benefits of a cyclic case scheduling approach that exploits a master surgical schedule (MSS). An MSS maximizes operating room (OR) capacity and simultaneously levels the outflow of patients toward the intensive care unit (ICU) to reduce surgery cancellation. Relevant data for Erasmus MC have been electronically collected since 1994. These data are used to construct an MSS that consisted of a set of surgical case types scheduled for a period or cycle. This cycle was executed repetitively. During such a cycle, surgical cases for each surgical department were scheduled on a specific day and OR. The experiments were performed for the Erasmus University Medical Center and for a virtual hospital. Unused OR capacity can be reduced by up to 6.3% for a cycle length of 4 weeks, with simultaneous optimal leveling of the ICU workload. Our findings show that the proposed cyclic OR planning policy may benefit OR utilization and reduce surgical case cancellation and peak demands on the ICU.Journal of Critical Care 07/2008; 23(2):222-6. · 2.13 Impact Factor -
Article: Closing emergency operating rooms improves efficiency.
[show abstract] [hide abstract]
ABSTRACT: Long waiting times for emergency operations increase a patient's risk of postoperative complications and morbidity. Reserving Operating Room (OR) capacity is a common technique to maximize the responsiveness of an OR in case of arrival of an emergency patient. This study determines the best way to reserve OR time for emergency surgery. In this study two approaches of reserving capacity were compared: (1) concentrating all reserved OR capacity in dedicated emergency ORs, and (2) evenly reserving capacity in all elective ORs. By using a discrete event simulation model the real situation was modelled. Main outcome measures were: (1) waiting time, (2) staff overtime, and (3) OR utilisation were evaluated for the two approaches. Results indicated that the policy of reserving capacity for emergency surgery in all elective ORs led to an improvement in waiting times for emergency surgery from 74 (+/-4.4) minutes to 8 (+/-0.5) min. Working in overtime was reduced by 20%, and overall OR utilisation can increase by around 3%. Emergency patients are operated upon more efficiently on elective Operating Rooms instead of a dedicated Emergency OR. The results of this study led to closing of the Emergency OR in the Erasmus MC (Rotterdam, The Netherlands).Journal of Medical Systems 01/2008; 31(6):543-6. · 1.13 Impact Factor -
Article: Improving operating room efficiency by applying bin-packing and portfolio techniques to surgical case scheduling.
[show abstract] [hide abstract]
ABSTRACT: An operating room (OR) department has adopted an efficient business model and subsequently investigated how efficiency could be further improved. The aim of this study is to show the efficiency improvement of lowering organizational barriers and applying advanced mathematical techniques. We applied advanced mathematical algorithms in combination with scenarios that model relaxation of various organizational barriers using prospectively collected data. The setting is the main inpatient OR department of a university hospital, which sets its surgical case schedules 2 wk in advance using a block planning method. The main outcome measures are the number of freed OR blocks and OR utilization. Lowering organizational barriers and applying mathematical algorithms can yield a 4.5% point increase in OR utilization (95% confidence interval 4.0%-5.0%). This is obtained by reducing the total required OR time. Efficient OR departments can further improve their efficiency. The paper shows that a radical cultural change that comprises the use of mathematical algorithms and lowering organizational barriers improves OR utilization.Anesthesia and analgesia 10/2007; 105(3):707-14. · 3.08 Impact Factor -
Article: A norm utilisation for scarce hospital resources: evidence from operating rooms in a Dutch university hospital.
[show abstract] [hide abstract]
ABSTRACT: Utilisation of operating rooms is high on the agenda of hospital managers and researchers. Many efforts in the area of maximising the utilisation have been focussed on finding the holy grail of 100% utilisation. The utilisation that can be realised, however, depends on the patient mix and the willingness to accept the risk of working in overtime. This is a mathematical modelling study that investigates the association between the utilisation and the patient mix that is served and the risk of working in overtime. Prospectively, consecutively, and routinely collected data of an operating room department in a Dutch university hospital are used. Basic statistical principles are used to establish the relation between realistic utilisation rates, patient mixes, and accepted risk of overtime. Accepting a low risk of overtime combined with a complex patient mix results a low utilisation rate. If the accepted risk of overtime is higher and the patient mix is less complex, the utilisation rate that can be reached is closer to 100%. Because of the inherent variability of healthcare processes, the holy grail of 100% utilisation is unlikely to be found. The method proposed in this paper calculates a realistic benchmark utilisation that incorporates the patient mix characteristics and the willingness to accept risk of overtime.Journal of Medical Systems 09/2007; 31(4):231-6. · 1.13 Impact Factor -
Article: Optimizing intensive care capacity using individual length-of-stay prediction models.
[show abstract] [hide abstract]
ABSTRACT: Effective planning of elective surgical procedures requiring postoperative intensive care is important in preventing cancellations and empty intensive care unit (ICU) beds. To improve planning, we constructed, validated and tested three models designed to predict length of stay (LOS) in the ICU in individual patients. Retrospective data were collected from 518 consecutive patients who underwent oesophagectomy with reconstruction for carcinoma between January 1997 and April 2005. Three multivariable linear regression models for LOS, namely preoperative, postoperative and intra-ICU, were constructed using these data. Internal validation was assessed using bootstrap sampling in order to obtain validated estimates of the explained variance (r2). To determine the potential gain of the best performing model in day-to-day clinical practice, prospective data from a second cohort of 65 consecutive patients undergoing oesophagectomy between May 2005 and April 2006 were used in the model, and the predictive performance of the model was compared with prediction based on mean LOS. The intra-ICU model had an r2 of 45% after internal validation. Important prognostic variables for LOS included greater patient age, comorbidity, type of surgical approach, intraoperative respiratory minute volume and complications occurring within 72 hours in the ICU. The potential gain of the best model in day-to-day clinical practice was determined relative to mean LOS. Use of the model reduced the deficit number (underestimation) of ICU days by 65 and increased the excess number (overestimation) of ICU days by 23 for the cohort of 65 patients. A conservative analysis conducted in the second, prospective cohort of patients revealed that 7% more oesophagectomies could have been accommodated, and 15% of cancelled procedures could have been prevented. Patient characteristics can be used to create models that will help in predicting LOS in the ICU. This will result in more efficient use of ICU beds and fewer cancellations.Critical care (London, England) 02/2007; 11(2):R42. · 4.61 Impact Factor -
Chapter: Wachttijdverkorting voor spoedpatiënten door schuiven met de planning van electieve operaties
[show abstract] [hide abstract]
ABSTRACT: ? Dit artikel gaat in op een planningsmethode die een hogere kwaliteit van zorg voor spoedpati?nten mogelijk maakt, zonder extra kosten. ? Wisselen van operaties binnen ??n OK leidt tot significante reductie van de wachttijden van spoedpati?nten op de OK. ? Wiskundige technieken kunnen op de OK eenvoudig worden ge?mplementeerd.01/2006: pages 147-154; -
Chapter: Hoge OK benutting en minder afgevallen patienten door cyclisch plannen
[show abstract] [hide abstract]
ABSTRACT: * Het gebruik van een cyclische OK-planningsmethode zorgt voor een effici?nte OK-benutting en een spreiding van de werkdruk op IC. De verantwoordelijkheid voor de pati?ntplanning ligt bij artsen. ? De realiseerbare effici?ntiewinst van de planningsmethode hangt samen met het pati?ntvolume en de pati?ntmix. ? Samenwerking van artsen, managers en wiskundigen zorgt voor een kwalitatief betere OK-planningsmethode die toepasbaar is in de praktijk.01/2006: pages 113-120; -
Chapter: Eén spoed-OK is géén spoed-OK
[show abstract] [hide abstract]
ABSTRACT: ? Kwaliteit van zorg, kwaliteit van arbeid en kosteneffici?ntie zijn belangrijke prestatiecriteria voor een OK-faciliteit. De besturing van een OK ten aanzien van het plannen van spoedoperaties hangt nauw samen met deze drie prestatiecriteria via de wachttijd van spoedpati?nten, uitloop van OK-programma?s en kosteneffici?ntie van de OK. ? In dit artikel vergelijken we drie concepten ten aanzien van het omgaan met spoedoperaties, met name het reserveren van OK-capaciteit ten behoeve van spoed. ? We tonen aan dat reserveren van capaciteit voor spoedoperaties op OK?s waar tevens electieve operaties worden uitgevoerd een positief effect heeft op de drie prestatiecriteria van een OK.01/2006: pages 165-172; -
Article: Dealing With Uncertainty in Multi-Project Rough-Cut Capacity
[show abstract] [hide abstract]
ABSTRACT: In this presentation we propose a method for dealing with uncertainty in the resource-constrained multi-project planning (RCCP) problem, by incorporating stochasticity. This tactical planning level is typically characterized by many uncertainties, such as processing time uncertainty, project release date delay, network uncertainty, rush orders, resource availability, project scenarios, etc.01/2002; -
Article: Robust surgery loading
[show abstract] [hide abstract]
ABSTRACT: We consider the robust surgery loading problem for a hospital’s operating theatre department, which concerns assigning surgeries and sufficient planned slack to operating room days. The objective is to maximize capacity utilization and minimize the risk of overtime, and thus cancelled patients. This research was performed in collaboration with the Erasmus MC, a large academic hospital in the Netherlands, which has also provided historical data for the experiments. We propose various constructive heuristics and local search methods that use statistical information on surgery durations to exploit the portfolio effect, and thereby to minimize the required slack. We demonstrate that our approach frees a lot of operating room capacity, which may be used to perform additional surgeries. Furthermore, we show that by combining advanced optimization techniques with extensive historical statistical records on surgery durations can significantly improve the operating room department utilization.European Journal of Operational Research.
Top co-authors
Top Journals
Institutions
-
2007–2008
-
Erasmus MC
Rotterdam, South Holland, Netherlands -
Erasmus Universiteit Rotterdam
Rotterdam, South Holland, Netherlands
-
