When the number of available beds in a hospital is limited, it can be beneficial to cluster several clinical departments such that the probability of not being able to admit a patient is acceptably small. However, not all clinical departments can be clustered for cross-infection reasons. In addition, patients from one clinical department should not be spread out over the entire hospital as this complicates the process of doing rounds and may result in alternate level of care. In this paper, we consider a situation where wards with a fixed number of beds are given. The question is how to cluster the clinical departments and to determine the assignment of these clustered departments to the available wards such that the assigned beds are sufficient to guarantee a blocking probability below a prespecified percentage. We first give an exact formulation of the problem to be able to achieve optimal solutions. However, computational experiments show that the resulting computation times for this model are too long for it to be applicable in practice. To reduce the computation time, we introduce two heuristic solution approaches. The first heuristic uses the same formulation as the exact model, however, the number of required beds is approximated by a linear function. The resulting model is again solved by an exact solver. The second heuristic uses a restricted version of the exact model within a local search approach. Hereby, the local search is used to determine the assignment of clinical departments to clusters and the exact model is used to determine the assignment of clusters to wards.@en

After surgery most of the surgical patients have to be admitted in a ward in the hospital. Due to financial reasons and a decreasing number of available nurses in the Netherlands over the years, it is important to reduce the bed usage as much as possible. One possible way to achieve this is to create an operating room (OR) schedule that spreads the usage of beds nicely over time, and thereby minimizes the number of required beds. An OR-schedule is given by an assignment of OR-blocks to specific days in the planning horizon and has to fulfill several resource constraints. Due to the stochastic nature of the length of stay of patients, the analytic calculation of the number of required beds for a given OR-schedule is a complex task involving the convolution of discrete distributions. In this paper, two approaches to deal with this complexity are presented. First, a heuristic approach based on local search is given that takes into account the detailed formulation of the objective. A second approach reduces the complexity by simplifying the objective function. This allows modeling and solving the resulting problem as an ILP. Both approaches are tested on data provided by Hagaziekenhuis in the Netherlands. Furthermore, several what-if scenarios are evaluated. The computational results show that the approach that uses the simplified objective function provides better solutions to the original problem for instances based on the situation in HagaZiekenhuis. By using this approach, the number of required beds for the considered instance of HagaZiekenhuis can be reduced by almost 20 %.

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Hospitals aim to deliver the highest quality of care. One key priority is to schedule emergency surgeries as quickly as possible, because postponing them generally increases a patient's risk of complications. In this paper, we consider the case that emergency surgeries are scheduled in one of the elective Operating Rooms (ORs). In this situation, emergency patients are operated once an ongoing elective surgery has finished. We denote these completion times of the elective surgeries by 'break-in-moments' (BIMs). The waiting time for emergency surgeries can be reduced by spreading these BIMs as evenly as possible over the day. This can be achieved by sequencing the surgeries in their assigned OR, such that the maximum interval between two consecutive BIMs is minimized. In this paper, we discuss several exact and heuristic solution methods for this new type of scheduling problem. However, in practice, emergency surgeries arising throughout the day and the uncertainty of the durations of elective surgeries, may disrupt the initial schedule. As a result, the completion times of the elective surgeries, and therefore, the BIMs change, leading also to a change of the maximum distance between two BIMs. To estimate this effect and investigate the robustness of the created schedules, we conduct a simulation study. Computational results show that the 'Fixed Goal Values' algorithm reduces the waiting time of emergency surgeries by approximately 10% when compared to the schedule used at the Erasmus Medical Centre.

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Due to surgery duration variability and arrivals of emergency surgeries, the planned Operating Room (OR) schedule is disrupted throughout the day which may lead to a change in the start time of the elective surgeries. These changes may result in undesirable situations for patients, wards or other involved departments, and therefore, the OR schedule has to be adjusted. In this paper, we develop a decision support system (DSS) which assists the OR manager in this decision by providing the three best adjusted OR schedules. The system considers the preferences of all involved stakeholders and only evaluates the OR schedules that satisfy the imposed resource constraints. The decision rules used for this system are based on a thorough analysis of the OR rescheduling problem. We model this problem as an Integer Linear Program (ILP) which objective is to minimize the deviation from the preferences of the considered stakeholders. By applying this ILP to instances from practice, we determined that the given preferences mainly lead to (i) shifting a surgery and (ii) scheduling a break between two surgeries. By using these changes in the DSS, the performed simulation study shows that less surgeries are canceled and patients and wards are more satisfied, but also that the perceived workload of several departments increases to compensate this. The system can also be used to judge the acceptability of a proposed initial OR schedule.

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We introduce the categorized reference database ORchestra, which is available online at http://www. utwente. nl/choir/orchestra/.@en