Operations Research for Pediatric Elective Surgery Planning: Example of a Mathematical Model

The management of operating rooms (ORs) is one of the most studied topics in operations research applied to healthcare. In particular, scheduling elective surgeries in a pediatric and teaching hospital can be a challenge because disruptions occur frequently. The aim of our research was to create a mathematical programming model to schedule day hospital (DH) patients, considering possible disruptions and defining how to best manage the rescheduling process. Our study originates from a collaboration between a high-volume pediatric surgery department and operations research practitioners. The possible disruptions we consider are emergencies and same-day cancellations of planned hospital operations. Elective DH surgeries are scheduled considering the waiting list and the patients' clinical priorities, generating a nominal schedule. This schedule is optimized in conjunction with a series of back-up schedules to guarantee that OR activity immediately recovers in case of a disruption. An ILP-based approach to the problem is proposed. We enumerate a representative subset of the possible emergency and no-show scenarios, and for each of them a back-up plan is designed. The approach reschedules patients, minimizing disruptions with respect to the nominal schedule, and applies an as-soon-as-possible policy in case of emergencies to ensure that all patients receive timely care. The approach is shown to be effective in managing disruptions, ensuring that the waiting list is managed properly, with a balanced mix of urgent and less urgent patients. It provides an effective solution for scheduling patients in a pediatric hospital, considering the unique features of such facilities.