Systematic Evaluation of Operating Room (OR) Scheduling Across the Perioperative (Peri-op) Process

We address two AHRQ priority areas, improving patient care in hospitals nationwide and improving health care delivery, by introducing a novel approach to operating room (OR) scheduling that manages disturbances to scheduling in real time. OR scheduling is a stepwise process involving generation of a service allocation plan, which gives rise to a master surgical schedule, which in turn yields a daily surgical slate that sequences surgical cases by operating rooms. This scheduling approach has been widely adopted by hospitals nationwide. The overall goal of our research is to improve perioperative efficiency while maintaining a high level of perioperative quality. To reach this goal we target two aims. Our first aim is to improve the efficiency of the OR scheduling process. Underlying this aim is the premise that greater efficiency in OR scheduling enhances perioperative value flow and patient flow. Value flow refers to the movement of perioperative resources and information. Patient flow refers to the movement of surgical patients through the perioperative process. Our second aim is to improve the effectiveness of OR scheduling at different temporal phases, planning, scheduling and adaptive control. The premise behind our second aim is that by incorporating adaptive control in our scheduling scheme, it will be more effective in managing the trade-offs between patient and value flows arising from disturbances in real time. We found improvement in OR utilization is not necessarily consistent with minimizing average case time. Most OR scheduling methods fail to address these inconsistencies. We use different models to mitigate inconsistencies in the two flows and in different phases. We evaluate the success of our OR scheduling approach by two types of efficiency. Technical efficiency occurs when the allocation of resources maximizes feasible output. We measure it as the difference in expected and actual performance for one flow relative to the other at a point in time. These difference ratios serve as inputs for forecasting and monitoring real time performance during the adaptive control phase. Economic efficiency occurs when costs are minimized. We measure economic efficiency as a benefit/cost ratio. The benefit/cost ratio is a summary indicator for the relationship between investment (e.g., the OR budget and resources captured in value flow) and output (e.g., patient throughput captured in patient flow). We define an optimization function to address different administrative preferences concerning the two flows. Combing feedback control (using SPC techniques) with feedforward control (using stochastic modeling and simulation), we enable OR schedulers to be proactive instead of reactive to disturbances. After proof of concept testing we will implement the scheduling process at one hospital in the UK HealthCare system, refine the approach as needed before implementing it across the three hospitals comprising the UK Healthcare system. Our OR scheduling approach addresses three important issues, (1) a theoretical control scheme to balance patient and value flows, (2) a practical solution for adaptive OR control, and (3) the successful application of industrial engineering techniques to quality improvement initiatives in the healthcare domain.