Schoenfelder Jan, Kohl Sebastian, Glaser Manuel, McRae Sebastian, Brunner Jens O, Koperna Thomas
Chair of Health Care Operations/Health Information Management, Faculty of Business and Economics, University of Augsburg, Universitätsstraße 16, 86159, Augsburg, Germany.
University Center of Health Sciences at Klinikum Augsburg (UNIKA-T), Neusässer Straße 47, 86156, Augsburg, Germany.
BMC Health Serv Res. 2021 Mar 24;21(1):271. doi: 10.1186/s12913-021-06234-5.
Since operating rooms are a major bottleneck resource and an important revenue driver in hospitals, it is important to use these resources efficiently. Studies estimate that between 60 and 70% of hospital admissions are due to surgeries. Furthermore, staffing cannot be changed daily to respond to changing demands. The resulting high complexity in operating room management necessitates perpetual process evaluation and the use of decision support tools. In this study, we evaluate several management policies and their consequences for the operating theater of the University Hospital Augsburg.
Based on a data set with 12,946 surgeries, we evaluate management policies such as parallel induction of anesthesia with varying levels of staff support, the use of a dedicated emergency room, extending operating room hours reserved as buffer capacity, and different elective patient sequencing policies. We develop a detailed simulation model that serves to capture the process flow in the entire operating theater: scheduling surgeries from a dynamically managed waiting list, handling various types of schedule disruptions, rescheduling and prioritizing postponed and deferred surgeries, and reallocating operating room capacity. The system performance is measured by indicators such as patient waiting time, idle time, staff overtime, and the number of deferred surgeries.
We identify significant trade-offs between expected waiting times for different patient urgency categories when operating rooms are opened longer to serve as end-of-day buffers. The introduction of parallel induction of anesthesia allows for additional patients to be scheduled and operated on during regular hours. However, this comes with a higher number of expected deferrals, which can be partially mitigated by employing additional anesthesia teams. Changes to the sequencing of elective patients according to their expected surgery duration cause expectable outcomes for a multitude of performance indicators.
Our simulation-based approach allows operating theater managers to test a multitude of potential changes in operating room management without disrupting the ongoing workflow. The close collaboration between management and researchers in the design of the simulation framework and the data analysis has yielded immediate benefits for the scheduling policies and data collection efforts at our practice partner.
由于手术室是医院的主要瓶颈资源和重要收入驱动因素，有效利用这些资源至关重要。研究估计，医院60%至70%的住院病例是由手术导致的。此外，无法每天改变人员配置以应对不断变化的需求。手术室管理中由此产生的高度复杂性使得需要持续进行流程评估并使用决策支持工具。在本研究中，我们评估了几种管理策略及其对奥格斯堡大学医院手术室的影响。
基于包含12946例手术的数据集，我们评估了多种管理策略，如在不同人员支持水平下并行诱导麻醉、使用专用急诊室、延长作为缓冲容量预留的手术室时间，以及不同的择期患者排序策略。我们开发了一个详细的模拟模型，用于捕捉整个手术室的流程：从动态管理的等待列表中安排手术、处理各种类型的日程中断、重新安排以及对推迟和延期手术进行优先级排序，并重新分配手术室容量。系统性能通过患者等待时间、空闲时间、员工加班时间以及延期手术数量等指标来衡量。
我们发现，当手术室开放更长时间以作为当日缓冲时，不同患者紧急程度类别的预期等待时间之间存在显著的权衡。引入并行诱导麻醉可使更多患者在正常工作时间内安排手术并进行操作。然而，这会导致预期延期手术数量增加，通过雇佣额外的麻醉团队可部分缓解这一情况。根据预期手术时长对择期患者进行排序的改变会对众多性能指标产生可预期的结果。
我们基于模拟的方法使手术室管理人员能够在不干扰正在进行的工作流程的情况下，测试手术室管理中的多种潜在变化。管理层与研究人员在模拟框架设计和数据分析方面的密切合作，已为我们的实践合作伙伴在调度策略和数据收集工作中带来了直接益处。
