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ORs are one of the most precious and costly resources in a hospital, accounting for over
40% of both the hospitals revenue and cost according to the Health Care Financial
Management Association. It is thus crucial to optimise the scheduling of ORs in order to
ensure maximal efficiency by maximising OR utilization and minimising the waiting time of
patients.
The problems and decisions associated with ORs scheduling is threefold: (1) Case-mix
problem (CMP), (2) Time block problem (TBP) and (3) Surgery scheduling problem (SSP).
The actual decision behind the CMP is determined through a simulation software. The
objective function that different hospital works towards is different. Some hospitals focus
more on the ultimate aim of improving OR utilisation, while others emphasize more on the
cost and revenue aspect. Since different team might specialise in different surgeries, the
revenue and cost associated will also be different.
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The benefits of block scheduling include the reduction of setup time due to the possibility of
scheduling multiple similar surgeries in a single time block. This is under the assumption that
these surgeries would largely utilise the same equipment. Another upside to block
scheduling is the potential reduction in idle time. If a surgery took less time than expected,
then the subsequent patient can begin at an earlier time.
It is important to recognise that there also exists a possibility of a surgery ending much later
than estimated. In this case, under the structure of block scheduling, there might not be
enough time left in the block to accommodate the subsequent patient. This might mean the
cancellation of the surgery, thus postponing it to a much later date.
TBP Alternative: Open scheduling
An alternative strategy to block scheduling is open scheduling. As the name suggests, the
use of fixed block time is abolished, and no time slots can be reserved for a particular team.
Sometime before the week (usually a few months), the surgical teams are able to register
the time slot and date that they wish to take up, after confirming the availability of the patient.
This is done on a first-come-first-serve basis (FCFS) each team is free to register any time
slots which have not yet been taken up by another team. The teams are able to register any
number of hours they wish, allowing them to take into account the probability that the
surgery might end earlier or later. The total hours that they can take up is subjected to their
assigned hours from the CMP.
Open scheduling offers additional flexibility to the surgical teams. To further address the
shortcomings of the block scheduling strategy, below are various potential improvements
that could be made to the open scheduling approach.
Open scheduling improvement : Assign across a week rather than a single day
Instead of directly arriving at a final surgery date with the patient, it might prove to be more
efficient to the hospital if the team first confirms with the patient a week where the surgery
would be scheduled to take place. A month prior to the planned week, the hospital
operations team can then consolidate all the surgeries that are scheduled for that week and
then allocate the time block for each surgery. When this information is disseminated to the
teams, then the patient can be notified accordingly.
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This modification helps to minimise the potential idle time that could result with open
scheduling. To illustrate, suppose that after rounds of registration, the only open time blocks
left are Monday 1600-1700 and Tuesday 1100-1200. If there exists an additional demand for
1 more surgery which is expected to take 2 hours, then it would be rejected as there are no
eligible time blocks. With the improvement proposed, the schedule above can be rearranged
such that there would be no more empty time blocks.