Surgical Case Sequencing and Patient Flow: A Simulation Study With Downstream Resources.

Area of Science:

• Healthcare Operations Research
• Health Systems Engineering
• Surgical Workflow Optimization

Background:

• Surgical case sequencing significantly impacts hospital patient flow and operational efficiency.
• Common heuristics like shortest case first (SCF) and longest case first (LCF) have been studied.
• The outpatient cases first (OPF) heuristic is widely used but lacks quantitative analysis regarding its operational impact.

Purpose of the Study:

• To propose and quantify the impact of the outpatient cases first (OPF) heuristic on hospital operations.
• To compare OPF against baseline, SCF, and LCF sequencing strategies using discrete event simulation.
• To evaluate the effects of partial OPF implementation and case shifting to ambulatory centers.

Main Methods:

• A discrete event simulation model was developed using SimPy.
• The simulation compared four scenarios: baseline, OPF, SCF, and LCF.
• Key performance indicators quantified included operating room (OR) and post-anesthesia care unit (PACU) holds, and last case completion times.

Main Results:

• OPF demonstrated a 54% decrease in OR holds and a 15% decrease in PACU holds compared to baseline.
• SCF increased OR holds by 22% and PACU holds by 11%.
• LCF increased OR holds by 37% but decreased PACU holds by 11%.
• Significant reductions in holds were achieved with partial OPF adoption, particularly with specific surgeon groups.
• OPF reduced average hold times more effectively than shifting cases to an ambulatory center.

Conclusions:

• Prioritizing outpatient procedures first (OPF) is an effective strategy for reducing patient flow delays in surgical settings.
• Implementation considerations include identifying surgeon groups with the greatest potential impact for maximizing benefits.
• OPF offers a quantifiable improvement in OR and PACU utilization and patient throughput.