Fügener Andreas, Edenharter Guenther Michael, Kiefer Paskal, Mayr Ulrike, Schiele Julian, Steiner Fabian, Kolisch Rainer, Blobner Manfred
From the *Universitaeres Zentrum fuer Gesundheitswissenschaften am Klinikum Augsburg (UNIKA-T), School of Business and Economics, Universitaet Augsburg, Augsburg, Germany; †Klinik fuer Anaesthesiologie, Klinikum rechts der Isar der TU Muenchen, Munich, Germany; and ‡TUM School of Management, Technische Universitaet Muenchen, Munich, Germany.
A A Case Rep. 2016 Mar 15;6(6):172-80. doi: 10.1213/XAA.0000000000000247.
With increasing organizational and financial pressure on hospitals, each individual surgical treatment has to be reviewed and planned thoroughly. Apart from the expensive operating room facilities, proper staffing and planning of downstream units, like the wards or the intensive care units (ICUs), should be considered as well. In this article, we outline the relationship between a master surgery schedule (MSS), i.e., the assignment of surgical blocks to medical specialties, and the bed demand in the downstream units using an analytical model. By using historical data retrieved from the clinical information system and a patient flow model, we applied a recently developed algorithm for predicting bed demand based on the MSSs for patients of 3 surgical subspecialties of a hospital. Simulations with 3 different MSSs were performed. The impact on the required amount of beds in the downstream units was analyzed. We show the potential improvements of the current MSS considering 2 main goals: leveling workload among days and reduction of weekend utilization. We discuss 2 different MSSs, one decreasing the weekend ICU utilization by 20% and the other one reducing maximum ward bed demand by 7%. A test with 12 months of real-life data validates the results. The application of the algorithm provides detailed insights for the hospital into the impact of MSS designs on the bed demand in downstream units. It allowed creating MSSs that avoid peaks in bed demand and high weekend occupancy levels in the ICU and the ward.
随着医院面临的组织和财务压力不断增加，每项外科手术治疗都必须进行全面审查和规划。除了昂贵的手术室设施外，还应考虑下游科室（如病房或重症监护病房（ICU））的合理人员配置和规划。在本文中，我们使用一个分析模型概述了主手术时间表（MSS）（即将手术时段分配给医学专科）与下游科室床位需求之间的关系。通过使用从临床信息系统检索到的历史数据和患者流模型，我们应用了一种最近开发的算法，根据一家医院3个外科亚专科患者的MSS来预测床位需求。对3种不同的MSS进行了模拟。分析了对下游科室所需床位数的影响。我们展示了考虑两个主要目标的当前MSS的潜在改进：平衡每日工作量和降低周末利用率。我们讨论了两种不同的MSS，一种将周末ICU利用率降低20%，另一种将病房最大床位需求降低7%。一项使用12个月实际数据的测试验证了结果。该算法的应用为医院提供了关于MSS设计对下游科室床位需求影响的详细见解。它能够创建避免床位需求高峰以及ICU和病房周末高占用率的MSS。
