Ferreira Rodrigo B, Coelli Fernando C, Pereira Wagner C A, Almeida Renan M V R
The Luiz Alberto Coimbra Institute, Federal University Rio de Janeiro - COPPE/UFRJ, Rio de Janeiro, Brazil.
J Eval Clin Pract. 2008 Dec;14(6):1031-7. doi: 10.1111/j.1365-2753.2007.00939.x.
This study used the discrete-events computer simulation methodology to model a large hospital surgical centre (SC), in order to analyse the impact of increases in the number of post-anaesthetic beds (PABs), of changes in surgical room scheduling strategies and of increases in surgery numbers.
The used inputs were: number of surgeries per day, type of surgical room scheduling, anaesthesia and surgery duration, surgical teams' specialty and number of PABs, and the main outputs were: number of surgeries per day, surgical rooms' use rate and blocking rate, surgical teams' use rate, patients' blocking rate, surgery delays (minutes) and the occurrence of postponed surgeries. Two basic strategies were implemented: in the first strategy, the number of PABs was increased under two assumptions: (a) following the scheduling plan actually used by the hospital (the 'rigid' scheduling - surgical rooms were previously assigned and assignments could not be changed) and (b) following a 'flexible' scheduling (surgical rooms, when available, could be freely used by any surgical team). In the second, the same analysis was performed, increasing the number of patients (up to the system 'feasible maximum') but fixing the number of PABs, in order to evaluate the impact of the number of patients over surgery delays.
It was observed that the introduction of a flexible scheduling/increase in PABs would lead to a significant improvement in the SC productivity.
本研究采用离散事件计算机模拟方法对一家大型医院的手术中心（SC）进行建模，以分析麻醉后床位（PAB）数量增加、手术室排班策略变化以及手术数量增加的影响。
使用的输入数据包括：每日手术数量、手术室排班类型、麻醉和手术时长、手术团队专业及PAB数量，主要输出数据包括：每日手术数量、手术室使用率和阻塞率、手术团队使用率、患者阻塞率、手术延迟（分钟）以及延期手术的发生率。实施了两种基本策略：在第一种策略中，在两种假设下增加PAB数量：（a）遵循医院实际使用的排班计划（“刚性”排班——手术室预先分配且分配不能更改）和（b）遵循“灵活”排班（手术室在可用时可由任何手术团队自由使用）。在第二种策略中，进行相同分析，增加患者数量（直至系统“可行最大值”）但固定PAB数量，以评估患者数量对手术延迟的影响。
观察到引入灵活排班/增加PAB数量将显著提高手术中心的生产率。
