Optimization and planning of operating theatre activities: an original definition of pathways and process modeling

BMC Medical Informatics and Decision Making

Research Article

Marina Iannucci¹  Simone Barbagallo¹  Nicola Rosso¹  Jean de Ville de Goyet¹  Angela Testi²  Elena Tanfani²  Luca Corradi³  Ivan Porro³ 

[1] Bambino Gesù Children’s Hospital, Piazza San Onofrio 4, 00165, Rome, Italy;Department of Economics and Business Studies, University of Genoa, Genoa, Italy;Nextage s.r.l, Genoa, Italy;

关键词: Clinical pathways;    Business Process Modeling;    Operating room planning and scheduling;   

DOI  :  10.1186/s12911-015-0161-7

 received in 2014-09-01, accepted in 2015-05-05,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundThe Operating Room (OR) is a key resource of all major hospitals, but it also accounts for up 40 % of resource costs. Improving cost effectiveness, while maintaining a quality of care, is a universal objective. These goals imply an optimization of planning and a scheduling of the activities involved. This is highly challenging due to the inherent variable and unpredictable nature of surgery.MethodsA Business Process Modeling Notation (BPMN 2.0) was used for the representation of the “OR Process” (being defined as the sequence of all of the elementary steps between “patient ready for surgery” to “patient operated upon”) as a general pathway (“path”). The path was then both further standardized as much as possible and, at the same time, keeping all of the key-elements that would allow one to address or define the other steps of planning, and the inherent and wide variability in terms of patient specificity. The path was used to schedule OR activity, room-by-room, and day-by-day, feeding the process from a “waiting list database” and using a mathematical optimization model with the objective of ending up in an optimized planning.ResultsThe OR process was defined with special attention paid to flows, timing and resource involvement. Standardization involved a dynamics operation and defined an expected operating time for each operation. The optimization model has been implemented and tested on real clinical data. The comparison of the results reported with the real data, shows that by using the optimization model, allows for the scheduling of about 30 % more patients than in actual practice, as well as to better exploit the OR efficiency, increasing the average operating room utilization rate up to 20 %.ConclusionsThe optimization of OR activity planning is essential in order to manage the hospital’s waiting list. Optimal planning is facilitated by defining the operation as a standard pathway where all variables are taken into account. By allowing a precise scheduling, it feeds the process of planning and, further up-stream, the management of a waiting list in an interactive and bi-directional dynamic process.

【 授权许可】

Unknown   
© Barbagallo et al.; licensee BioMed Central. 2015. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.