基于NWHFS的手术室资源调度研究
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摘要
手术室的利用效率是医院管理的关键要素之一,其水平的高低严重影响着医院的运营成本以及服务质量水平,较低的手术室利用效率表现为手术室空闲状况严重、手术室人员利用效率不高、手术之间存在严重时间空闲等。分析其产生的原因,主要是手术病例调度的不合理,造成很多手术之间无故的时间浪费。本文通过对手术流程的分析,将手术病例与作业调度结合起来,尝试用调度理论对该问题进行研究,并提出相应的提高手术室利用率的方法。
主要成果如下:
第一、通过分析现代医院手术室效率低下的各个原因,提出手术病例调度在医院管理中的重大作用。
第二、对手术病人、手术病例调度进行分类,并详细的分析了手术的流程以及各个环节,同时将手术调度与作业调度之间进行了比较、分析,提出利用作业调度方法来解决手术病例调度的问题。
第三、对分派病例调度进行分析,将分派病例调度抽象出NWHFS无等待混合流水作业问题,并对此建立数学模型。另外、考虑到手术室的独特特点,依据手术室与病床的关系,分三种情况对该模型进行了讨论。
第四、通过对实际医院数据的统计,分析了该医院手术室使用率的实际情况,并利用模型对手术病例进行调度,提出了提高手术室利用率的相关方法,验证了方法的可行性。
手术病例调度的目的在于运用科学的方法对手术病例进行合理的调度、在满足病例手术完成的前提下最大限度的提高手术室的利用效率、不增加医生的额外工作时间,降低成本、提升病人与医生的满意度、提高医院的竞争力。
The efficiency of operating room is a key element of the hospital management, which has a serious impact on the hospital’s costs, as well as the level of service quality. The bad utilization of operating room performs that the serious vacancy of operating room, the idleness of personnel, and lots of disengagement in the surgeries. By analyzing this problem, we find that the main reason is that the surgery scheduling is unreasonable, which wastes a lot of operating time. By analyzing the surgical procedures, this paper combines the surgery scheduling with job scheduling, tries to study this problem using scheduling theory, and proposes some relevant methods to improve the occupancy rate of operating room.
The major research results include the followings:
First, this paper analyzes the reasons for the low efficiency of operating room in modern hospitals and elucidates the significance of surgery scheduling in hospital management.
Secondly, the surgical patients and surgical scheduling are classified, and the process is analyzed in detail as well as all aspects of surgery. At the same time, we compare the scheduling of operating room and job scheduling, and propose a way to solve the surgical scheduling problem using the theory of job scheduling.
Third, we analyze the allocation scheduling and establish a NWHFS mathematical model. Taking the characteristics of operating room into account, three cases are discussed according to the relations between the operating rooms and beds.
Fourth, we make a data statistics, analyze the occupancy rate of operating room in hospital, and make a re-arrangement to the surgical cases using scheduling theory. Then we propose some methods to improve the efficiency of operating room and prove the feasibility of the methods.
The mainly aim of surgery scheduling is to make a reasonable scheduling to surgery, improve the efficiency of operating room under the condition that the surgery is completed, cut the additional working hours of doctors, and improves the competitiveness of hospitals.
主要成果如下:
第一、通过分析现代医院手术室效率低下的各个原因,提出手术病例调度在医院管理中的重大作用。
第二、对手术病人、手术病例调度进行分类,并详细的分析了手术的流程以及各个环节,同时将手术调度与作业调度之间进行了比较、分析,提出利用作业调度方法来解决手术病例调度的问题。
第三、对分派病例调度进行分析,将分派病例调度抽象出NWHFS无等待混合流水作业问题,并对此建立数学模型。另外、考虑到手术室的独特特点,依据手术室与病床的关系,分三种情况对该模型进行了讨论。
第四、通过对实际医院数据的统计,分析了该医院手术室使用率的实际情况,并利用模型对手术病例进行调度,提出了提高手术室利用率的相关方法,验证了方法的可行性。
手术病例调度的目的在于运用科学的方法对手术病例进行合理的调度、在满足病例手术完成的前提下最大限度的提高手术室的利用效率、不增加医生的额外工作时间,降低成本、提升病人与医生的满意度、提高医院的竞争力。
The efficiency of operating room is a key element of the hospital management, which has a serious impact on the hospital’s costs, as well as the level of service quality. The bad utilization of operating room performs that the serious vacancy of operating room, the idleness of personnel, and lots of disengagement in the surgeries. By analyzing this problem, we find that the main reason is that the surgery scheduling is unreasonable, which wastes a lot of operating time. By analyzing the surgical procedures, this paper combines the surgery scheduling with job scheduling, tries to study this problem using scheduling theory, and proposes some relevant methods to improve the occupancy rate of operating room.
The major research results include the followings:
First, this paper analyzes the reasons for the low efficiency of operating room in modern hospitals and elucidates the significance of surgery scheduling in hospital management.
Secondly, the surgical patients and surgical scheduling are classified, and the process is analyzed in detail as well as all aspects of surgery. At the same time, we compare the scheduling of operating room and job scheduling, and propose a way to solve the surgical scheduling problem using the theory of job scheduling.
Third, we analyze the allocation scheduling and establish a NWHFS mathematical model. Taking the characteristics of operating room into account, three cases are discussed according to the relations between the operating rooms and beds.
Fourth, we make a data statistics, analyze the occupancy rate of operating room in hospital, and make a re-arrangement to the surgical cases using scheduling theory. Then we propose some methods to improve the efficiency of operating room and prove the feasibility of the methods.
The mainly aim of surgery scheduling is to make a reasonable scheduling to surgery, improve the efficiency of operating room under the condition that the surgery is completed, cut the additional working hours of doctors, and improves the competitiveness of hospitals.
引文
[1]Valenzuela RC, Johnstone RE, Cost containment in anesthesiology: a survey of department activities, J Clin Anesth 1997, 18(9): 3~106
[2]曹秀堂,董军等,反映手术间利用效率的统计指标与方法探讨,中国卫生统计,解放军总医院(100853),2003,20(2)
[3]Franklin Dexter, MD, PhD, Bed Management Displays to Optimize Patient Flow From the OR to the PACU, Journal of PertAnesthesta Nursing, 22(3), 2007:218~219
[4]S.Noyan Ogulata, M.Oya Cetik, Esra Koyuncu, A Simulation Approach for Scheduling Patients in the Department of Radiation Oncology, 2008,6:120~135
[5]Dexter, F. Macario, A. Traub, R.D.,Hopwood,M.,Lubarsky,D.A.,1999b, An operating room scheduling strategy to maximize the use of operating room block time: Computer simulation of patient scheduling and survey of patients preferences for surgical waiting time. Anesthesia and Analgesia 89(1):7~20
[6]I.Ozkarahan, Allocation of surgical procedures to Operating Rooms, Journal of Medical Systems 1995,19(4): 333~352
[7]F. Dexter, A .Macario, D.Rodney, Which algorithm for scheduling add-on elective cases maximizes OR utilization? Use of bin packing algorithms and fuzzy constraints in OR management, Anesthesiology 1999, 91(5):1491~1501
[8]Jeroen Beli?n, Exact and heuristic methodologies for scheduling in hospital: problems, formulations and algorithms, 4OR, 2007,(5):157~160
[9]N.E,Model for determining estimated start times and case orderings in hospitals Ors, IIE Transaction 1988 , (22):143~150
[10]F. Dexter, F. Macario, R.D. Traub, Optimal sequencing of Urgent surgical cases, Journal of Clinical Monitoring and Computing1999,( 15)153~162
[11]Gerchak et al., Reservation planning for elective surgery under uncertain demand for emergency surgery, Management Science 1996,(42):321~333
[12]Mehdi Lamiri*, Xiaolan Xie, Alexandre Dolgui, Fre′de′ricGrimaud, A stochastic model for operating room planning with elective and emergency demand for surgery, European Journal of operational Research 2008, (185): 1026~1037
[13]McQuarrie, Limits to efficient operating room scheduling: Lessons from computer-use models. Arch. 1981(116):1065~1071
[14]Pablo Santiba/nez, Mehmet Begen, Derek Atkins, Surgical block scheduling in a system of hospitals: an application to resource and waitlist management in a British Columbia health authority, Health Care Manage Sci2007(10):269~282
[15]Morgan, D.M., Block booking in the OR—A solution to a multitude of sins.Can.Hosp.,1972,49
[16]Morgan, D.M., Improved scheduling through block booking, Can. Hosp.1973
[17] Lamont, C.A., An OR block booking system. Hosp. Adm. Can. 1974,16
[18]Rinde A., Blakey T., OR resource utilization. Chicago Hospital Council, Chicago, 1974
[19]Tanik Y., A research on goal programming and related topics in multi-objective decision making with an application in operating rooms scheduling, Masters Thesis, Dokuz Eylul University, 1996
[20]Irem Ozkarahan, Allocation of Surgeries to Operating Rooms by Goal Programing, Journal of Medical Systems, Vol.24,NO.6,2000
[21]D.Sier, P.Tobin, C.Mcgurk, Scheduling surgical procedures, Journal of the Operational Research Society 1997,(48):884~891
[22]S.Noyan Ogulata﹒Melik Koyuncu﹒Esra Karakas, .Personnel and Patient Scheduling in the high demand hospital service : A case study in the Physiotherapy Service, J Med Syst 2008,32:221~228
[23]Alexandre Beaudry. Gilbert Laporte.Teresa Melo Stefan Nickel, Dynamic transportation of patients in hospital,OR Spectrum,DOl 10.007/s00291-008-0135-6
[24]F. Dexter, R.D., raub, How to schedule elective surgical cases into specific Operating Room to maximize efficiency of use of OR time? Anesthesiology 2002,(97):933~942
[25]Fairman, W.L., Scheduling/Resource Level Decisions in the Hospital Operating Room Environment, Doctoral Dissertation, Dept of Engineering, University of Pittsburgh,1971
[26]Brian Denton·James Viapiano﹒ Andrea Vogl, Optimization of surgery sequencing and scheduling decisions under uncertainty, Health Care Manage Sci 2007,(10):13~24
[27]S.Noyan Ogulata1,2,3 and Rizvan Erol2, A Hierarchical Multiple Criteria Mathematical Programming Approach for Scheduling General Surgery Operations in Large Hospitals, Journal of Medical Systems,2003,Vol.27, No.3
[28]Angela Testi&Elena Tanfani&Giancarlo Torre, A three-phase approach for operating theatre schedules, Health Care Manage Sci,2007(10):163~172
[29]Dinh-Nguyen Pham*,Andreas Klinkert , Surgical case scheduling as a generalized job shop Scheduling problem, European Journal of Operational Research 2008,( 185) :1011~1025
[30]Alain Guinet*, Sondes Chaabane, Operating theatre planning , International Journal of Production Economics 2003,( 85): 69~81.
[31]Guinet A,ChaabaneS,Operating theatre planning, Int J Prod Econ 2003 (85):69~81
[32]C.Y.Lee, R.Matta, V.N.Hsu, Scheduling patients in an Ambulatory surgical center, Naval Research Logistics 2002, 50(3):218~238.
[33]Kharraja, S., Chaabane,S., Marcon,E.,2002.Evaluation deperformances pour deux strategies de programmation operatoire de bloc,Actes de 2 Conference Internationale Francophone d’Automatique, Nantes France
[34]Aida Jebalia,*,Atidel B. Hadj Alouaneb,Pierre Ladeta, Operating rooms scheduling, Int. J. Production Economics ,2006,(99) 52~62
[35]James E McGowan,, Jonathon D. Truwit, Pam Cipriano, R Edward Howell, Margaret VanBree, Arthur Garson Jr, John B Hanks, Operating Room Efficiency and Hospital Capacity:Factors Affecting Operating Room Use During Maximum Hospital Census, Journal of the American College of Surgeons,2007,204(5): 865~871
[36]F. Dexter et al., Strategies to reduce delays in admission into a PACU from Operating Rooms, Journal of Peri Anesthesia Nursing ,2005,20(2): 92~102
[37]Kildea,J., Operating room scheduling methods: The two room system, Hospitals 1970,44:99~101
[38]Przasnyski, Z. H., Operating room scheduling: A literature review. [J],AORN 1986,(44)
[39]Eric Marcon*, Sald Kharraja, Ge’rard, Simonnet, The operating theatre planning by the follow-up of the risk of no realization, Int, J. Production Economics 2003,(85): 83~90
[40]Dexter F, Traub RD,How to schedule elective surgical cases into specific operating rooms to maximize the efficiency of use of operating room time, Anesth Analg 2002,(94):933~942
[41]Dexter F ,Macario A, Traub RD, Which algorithm for Scheduling add-on elective cases maximizes operating room utilization?. Anesthesiology, 1999, (91): 1491~1500
[42]Shukla, R.K., Ketcham, J.S., Ozcan, Y.A., 1990. Comparison of subjective versus data base approaches for improving efficiency of operating room scheduling, Health Services Management Research3, 74~81
[43]Zhou, J., Dexter, F.Method to assist in the scheduling of add-on surgical cases, Upper prediction bounds for surgical case durations based on the log–normal distribution. Anesthesiology 1998,89 (5):1228~1232
[44]Walton M.Hancock, Paul F. Walter, Roy A. More, Noah D.Glick, Operating Room Scheduling Data Base Analysis for Scheduling, Journal of Medical Systems, 1988,12( 6)
[45]Guinet A, Chaabane S, Operating theatre planning, Int J Prod Econ 2003,(85):69~81
[46]Blake JT,,Dexter F, Donald J, Operating room manager's use of integer programming for assigning block time to surgical groups: a case study. AnesthAnalg, 2002,(94):143~148
[47]F. Dexter, R.D., raub, How to schedule elective surgical cases into specific Operating Room to maximize efficiency of use of OR time? Anesthesiology 2002,(94):933~942
[48]Avi A. Weinbroum, M.D.a,b,d,*, Perla Ekstein, M.D.b,d, Tiberiu Ezri,M.D.c,d, Efficiency of the operating room suite, The American Journal of Surgery 2003, (185): 244~250
[49]Beli?n J, Demeulemeester E , Integer programming for Building robust surgery schedules, Working paper ,Katholieke Universiteit Leuven, 2004
[50]Blake JT, Donald J, Mount Sinai Hospital uses integer programming to allocate operating room time. Interfaces 2002,32(2):63~73
[51]王莉、曾俊、程勤等,合理利用现有资源提高手术室工作效率,解放军护理杂志2005.1.22
[52]王雪岩王亚卿审校,手术室效率的研究进展,国外医学护理学分册,1999,18(5)
[53]王莉,曾俊,程勤等,合理利用现有资源提高手术室工作效率,解放军护理杂志2005,22(1)
[54] Magerlein, J & martin, J,‘Surgical Demand Scheduling: A Review’, Health Services Research, 1978, (13)4:418~433
[55]Mintzberg, H, The Structuring of Organizations, Prentice-Hall, Englewood Cliffs, NJ, 1978
[56]Lamont, C.A., An OR block booking system, Hosp. Adm. Can., 1974, 16
[57]Operating Room Benchmarks, OR Manager, August 2000, 16(8)
[58]唐恒永、赵传立,排序引论,北京:科学出版社,2002:2~9,115
[2]曹秀堂,董军等,反映手术间利用效率的统计指标与方法探讨,中国卫生统计,解放军总医院(100853),2003,20(2)
[3]Franklin Dexter, MD, PhD, Bed Management Displays to Optimize Patient Flow From the OR to the PACU, Journal of PertAnesthesta Nursing, 22(3), 2007:218~219
[4]S.Noyan Ogulata, M.Oya Cetik, Esra Koyuncu, A Simulation Approach for Scheduling Patients in the Department of Radiation Oncology, 2008,6:120~135
[5]Dexter, F. Macario, A. Traub, R.D.,Hopwood,M.,Lubarsky,D.A.,1999b, An operating room scheduling strategy to maximize the use of operating room block time: Computer simulation of patient scheduling and survey of patients preferences for surgical waiting time. Anesthesia and Analgesia 89(1):7~20
[6]I.Ozkarahan, Allocation of surgical procedures to Operating Rooms, Journal of Medical Systems 1995,19(4): 333~352
[7]F. Dexter, A .Macario, D.Rodney, Which algorithm for scheduling add-on elective cases maximizes OR utilization? Use of bin packing algorithms and fuzzy constraints in OR management, Anesthesiology 1999, 91(5):1491~1501
[8]Jeroen Beli?n, Exact and heuristic methodologies for scheduling in hospital: problems, formulations and algorithms, 4OR, 2007,(5):157~160
[9]N.E,Model for determining estimated start times and case orderings in hospitals Ors, IIE Transaction 1988 , (22):143~150
[10]F. Dexter, F. Macario, R.D. Traub, Optimal sequencing of Urgent surgical cases, Journal of Clinical Monitoring and Computing1999,( 15)153~162
[11]Gerchak et al., Reservation planning for elective surgery under uncertain demand for emergency surgery, Management Science 1996,(42):321~333
[12]Mehdi Lamiri*, Xiaolan Xie, Alexandre Dolgui, Fre′de′ricGrimaud, A stochastic model for operating room planning with elective and emergency demand for surgery, European Journal of operational Research 2008, (185): 1026~1037
[13]McQuarrie, Limits to efficient operating room scheduling: Lessons from computer-use models. Arch. 1981(116):1065~1071
[14]Pablo Santiba/nez, Mehmet Begen, Derek Atkins, Surgical block scheduling in a system of hospitals: an application to resource and waitlist management in a British Columbia health authority, Health Care Manage Sci2007(10):269~282
[15]Morgan, D.M., Block booking in the OR—A solution to a multitude of sins.Can.Hosp.,1972,49
[16]Morgan, D.M., Improved scheduling through block booking, Can. Hosp.1973
[17] Lamont, C.A., An OR block booking system. Hosp. Adm. Can. 1974,16
[18]Rinde A., Blakey T., OR resource utilization. Chicago Hospital Council, Chicago, 1974
[19]Tanik Y., A research on goal programming and related topics in multi-objective decision making with an application in operating rooms scheduling, Masters Thesis, Dokuz Eylul University, 1996
[20]Irem Ozkarahan, Allocation of Surgeries to Operating Rooms by Goal Programing, Journal of Medical Systems, Vol.24,NO.6,2000
[21]D.Sier, P.Tobin, C.Mcgurk, Scheduling surgical procedures, Journal of the Operational Research Society 1997,(48):884~891
[22]S.Noyan Ogulata﹒Melik Koyuncu﹒Esra Karakas, .Personnel and Patient Scheduling in the high demand hospital service : A case study in the Physiotherapy Service, J Med Syst 2008,32:221~228
[23]Alexandre Beaudry. Gilbert Laporte.Teresa Melo Stefan Nickel, Dynamic transportation of patients in hospital,OR Spectrum,DOl 10.007/s00291-008-0135-6
[24]F. Dexter, R.D., raub, How to schedule elective surgical cases into specific Operating Room to maximize efficiency of use of OR time? Anesthesiology 2002,(97):933~942
[25]Fairman, W.L., Scheduling/Resource Level Decisions in the Hospital Operating Room Environment, Doctoral Dissertation, Dept of Engineering, University of Pittsburgh,1971
[26]Brian Denton·James Viapiano﹒ Andrea Vogl, Optimization of surgery sequencing and scheduling decisions under uncertainty, Health Care Manage Sci 2007,(10):13~24
[27]S.Noyan Ogulata1,2,3 and Rizvan Erol2, A Hierarchical Multiple Criteria Mathematical Programming Approach for Scheduling General Surgery Operations in Large Hospitals, Journal of Medical Systems,2003,Vol.27, No.3
[28]Angela Testi&Elena Tanfani&Giancarlo Torre, A three-phase approach for operating theatre schedules, Health Care Manage Sci,2007(10):163~172
[29]Dinh-Nguyen Pham*,Andreas Klinkert , Surgical case scheduling as a generalized job shop Scheduling problem, European Journal of Operational Research 2008,( 185) :1011~1025
[30]Alain Guinet*, Sondes Chaabane, Operating theatre planning , International Journal of Production Economics 2003,( 85): 69~81.
[31]Guinet A,ChaabaneS,Operating theatre planning, Int J Prod Econ 2003 (85):69~81
[32]C.Y.Lee, R.Matta, V.N.Hsu, Scheduling patients in an Ambulatory surgical center, Naval Research Logistics 2002, 50(3):218~238.
[33]Kharraja, S., Chaabane,S., Marcon,E.,2002.Evaluation deperformances pour deux strategies de programmation operatoire de bloc,Actes de 2 Conference Internationale Francophone d’Automatique, Nantes France
[34]Aida Jebalia,*,Atidel B. Hadj Alouaneb,Pierre Ladeta, Operating rooms scheduling, Int. J. Production Economics ,2006,(99) 52~62
[35]James E McGowan,, Jonathon D. Truwit, Pam Cipriano, R Edward Howell, Margaret VanBree, Arthur Garson Jr, John B Hanks, Operating Room Efficiency and Hospital Capacity:Factors Affecting Operating Room Use During Maximum Hospital Census, Journal of the American College of Surgeons,2007,204(5): 865~871
[36]F. Dexter et al., Strategies to reduce delays in admission into a PACU from Operating Rooms, Journal of Peri Anesthesia Nursing ,2005,20(2): 92~102
[37]Kildea,J., Operating room scheduling methods: The two room system, Hospitals 1970,44:99~101
[38]Przasnyski, Z. H., Operating room scheduling: A literature review. [J],AORN 1986,(44)
[39]Eric Marcon*, Sald Kharraja, Ge’rard, Simonnet, The operating theatre planning by the follow-up of the risk of no realization, Int, J. Production Economics 2003,(85): 83~90
[40]Dexter F, Traub RD,How to schedule elective surgical cases into specific operating rooms to maximize the efficiency of use of operating room time, Anesth Analg 2002,(94):933~942
[41]Dexter F ,Macario A, Traub RD, Which algorithm for Scheduling add-on elective cases maximizes operating room utilization?. Anesthesiology, 1999, (91): 1491~1500
[42]Shukla, R.K., Ketcham, J.S., Ozcan, Y.A., 1990. Comparison of subjective versus data base approaches for improving efficiency of operating room scheduling, Health Services Management Research3, 74~81
[43]Zhou, J., Dexter, F.Method to assist in the scheduling of add-on surgical cases, Upper prediction bounds for surgical case durations based on the log–normal distribution. Anesthesiology 1998,89 (5):1228~1232
[44]Walton M.Hancock, Paul F. Walter, Roy A. More, Noah D.Glick, Operating Room Scheduling Data Base Analysis for Scheduling, Journal of Medical Systems, 1988,12( 6)
[45]Guinet A, Chaabane S, Operating theatre planning, Int J Prod Econ 2003,(85):69~81
[46]Blake JT,,Dexter F, Donald J, Operating room manager's use of integer programming for assigning block time to surgical groups: a case study. AnesthAnalg, 2002,(94):143~148
[47]F. Dexter, R.D., raub, How to schedule elective surgical cases into specific Operating Room to maximize efficiency of use of OR time? Anesthesiology 2002,(94):933~942
[48]Avi A. Weinbroum, M.D.a,b,d,*, Perla Ekstein, M.D.b,d, Tiberiu Ezri,M.D.c,d, Efficiency of the operating room suite, The American Journal of Surgery 2003, (185): 244~250
[49]Beli?n J, Demeulemeester E , Integer programming for Building robust surgery schedules, Working paper ,Katholieke Universiteit Leuven, 2004
[50]Blake JT, Donald J, Mount Sinai Hospital uses integer programming to allocate operating room time. Interfaces 2002,32(2):63~73
[51]王莉、曾俊、程勤等,合理利用现有资源提高手术室工作效率,解放军护理杂志2005.1.22
[52]王雪岩王亚卿审校,手术室效率的研究进展,国外医学护理学分册,1999,18(5)
[53]王莉,曾俊,程勤等,合理利用现有资源提高手术室工作效率,解放军护理杂志2005,22(1)
[54] Magerlein, J & martin, J,‘Surgical Demand Scheduling: A Review’, Health Services Research, 1978, (13)4:418~433
[55]Mintzberg, H, The Structuring of Organizations, Prentice-Hall, Englewood Cliffs, NJ, 1978
[56]Lamont, C.A., An OR block booking system, Hosp. Adm. Can., 1974, 16
[57]Operating Room Benchmarks, OR Manager, August 2000, 16(8)
[58]唐恒永、赵传立,排序引论,北京:科学出版社,2002:2~9,115