Breaking down the walls between OR and ward : how to ba;ance ward workload without harming OR utilization

This study is performed in the period of May 2010 to January 2011 at Gelre Apeldoorn on request of the manager patient logistics. Goal of this study was “To investigate recurring OR planning policies that can help stabilize ward workload, and lead to an acceptable level of OR utilization for Gelre Apeldoorn”. Background Gelre Apeldoorn is a Medical Teaching Hospital and one of the larger regional hospitals in the Netherlands. Due to increased spending in healthcare, it becomes increasingly important to reduce costs of healthcare and to optimize processes in hospitals. Gelre Apeldoorn uses the Operating Room (OR) department efficiently, but problems occur when multiple departments need to cooperate. Workload on nursing wards for example, differs among the days of the week and surgeries often have to wait for the availability of X-Ray equipment. Research approach First, we analyzed surgical data and interviewed the stakeholders in order to describe the current situation. In 2008, utilization of the OR department was 84 percent, which is high compared to other OR departments in the Netherlands. In 2008, ward utilization for the surgical specialties during working days was 98 percent, measured in nursing days. Utilization is this high because we measure nursing days and we included the day-care ward, where during a day multiple patients use the same bed after each other.Second, we developed a heuristic to distinguish surgery types, which are groups of medically homogeneous surgical procedures, based on their logistic characteristics. These surgery types are input for the simulation program “OR-manager”, which we use to evaluate the performance of the planning policies we investigate. Finally, we test the performance of three versions of a Master Surgical Schedule (MSS). An MSS optimized on standard deviation of OR utilization, on standard deviation of ward utilization and on standard deviation of admissions and discharges. We tested these interventions with 2008 data and with 2011 data with the current (fixed) allocation of specialties to ORs and with an optimized allocation of specialties to ORs. Results • An MSS optimized on the standard deviation of daily ward utilization and with optimized (unrestricted) allocation of specialties to ORs saves 13 beds (6% reduction compared to the current planning policy and restricted allocation) during the peak utilization of the ward. Also, workload at the ward levels. The standard deviation of utilization declines with 23% and the standard deviation of the number of admittance and discharges declines with 47%. In order to reach these improvements, 12 changes in the schedule are necessary. • An MSS optimized on the standard deviation of ward utilization and with fixed allocation of specialties to ORs saves 8 beds. The standard deviation of ward utilization declines with 18% and the standard deviation of the number of admittance and discharges declines with 35%. An extra advantage of introducing an MSS, is that it creates the possibility for patients to plan their surgery directly at the outpatient ward. This means an increase in customer satisfaction level for the patient. Conclusions The best performing recurring OR planning policy we investigated is an MSS optimized on daily ward utilization and with optimized allocation of specialties to ORs. It stabilizes the workload at the wards, without deteriorating the performance of the OR department. Recommendations • Implement an MSS optimized on the standard deviation of daily ward utilization with the current (fixed) allocation of specialties to ORs. This makes implementation easier, because it leaves the schedules of specialist unchanged. • Incorporate the employees who need to work with the planning in all stages. It is helpful that they see the goals and the necessity of implementing an MSS. From that moment on, it is possible to use their knowledge of the surgeries and preferences of the specialist, to create the best possible surgery types and schedule. • Investigate which swaps of OR days have the highest impact on the performance of ORs and wards and investigate the possibilities to incorporate these swaps in new OR schedules. • Further research should involve the influence of urgent and emergency surgeries on the performance of the MSS, improving optimization heuristics and the inclusion of outpatient wards.