Asymmetric surge optimization during peak seasons: a discrete-event simulation of centralized fast-track operating...

Holiday-related effects result in a substantial surge in the volume of pediatric surgeries. Managing operating room (OR) capacity during summer holiday is immensely challenging for a China National Children's Medical Center. A surge of pediatric surgeries is inherently asymmetric, characterized by a disproportionate increase in short elective procedures, while the volume of complex surgeries remains relatively stable. Traditional mixed-acuity scheduling or naive departmental segregation often results in severe capacity fragmentation. This study employs discrete-event simulation (DES) to propose and evaluate an asymmetric, centralized fast-track OR allocation strategy.

Using retrospective, de-identified operational data from Shanghai Children's Medical Center, a National Children's Medical Center in China, we constructed a DES model representing the workflow of diverse surgical departments. Following a retrospective iterative calibration ensuring <2% baseline error, we introduced a Prospective Simulation Probing (PSP) mechanism under a dynamic safety-buffer policy to determine variance-penalized daily capacities. In the primary optimized scenario, fast-track turnover was modeled as Triangle (10, 12.5, 15) minutes rather than regular-OR Triangle (25, 27.5, 30) minutes, corresponding to a 15-minute mean reduction; 5- and 10-minute reduction scenarios were tested separately. OR days were first allocated to secure historical complex surgery volumes, after which residual days were pooled into a centralized fast-track center. Uncertainty was summarized as mean, SD, median, and 95% simulation intervals; sensitivity analyses varied turnover reduction, bounded fast-track demand, and edge-case fast-track classification.

Simulation revealed that simplistic departmental segregation penalized low-volume specialties, reducing their throughput due to idle-time waste. Conversely, the asymmetric centralized pooling model protected severe, slow-track case throughput while increasing fast-track capacity. The optimized 15-minute turnover-reduction scenario yielded a mean total throughput of 3,588.7 cases (median 3,589; 95% simulation interval, 3,562-3,614), corresponding to a 38.29% increase over the historical baseline of 2,595 cases (95% interval for increase, 37.26%-39.27%). Under the more conservative 10-minute reduction scenario, mean throughput was 3,208.3 cases, a 23.63% increase.

DES modeling suggests that overcoming pediatric surgery surge requires separating short fast-track procedures from complex surgeries while explicitly protecting complex-care access. Consolidating short procedures into dedicated, homogeneous ORs can reduce non-operative turnover waste and increase throughput; however, implementation depends on staffing flexibility, sufficient fast-track demand, and local cost considerations.