Multi-criteria Optimization Scheduling of Surgical Units: a Case Study at AOU-Policlinico Umberto I

Nowadays, Operating Rooms (ORs) scheduling and planning represent one of the most challenging aspects in healthcare systems management. In particular, one of the main concern is doubtless the under-use of the surgery rooms, that one can tackle by modelling different management decision aspects. The number of ORs available in the operating theatre and their daily opening time, the ideal OR Utilization Rate (UR) that the hospital aims to fulfil, the possibility to transfer patients between different surgical units (SUs) are just some of them. Taking into account these management and economic factors, we develop a multi-criteria integer linear optimization model for the advance scheduling of patients for the Azienda Ospedaliera - Universitaria Policlinico Umberto I of Rome, among the largest public hospitals in Europe for by total area occupied. The problem is formulated according to an open scheduling strategy that, for each surgical case placed on a waiting list, determines the date, time, and operating room resources needed. Extensive tests were carried out on real data collected during twelve weeks in two SUs, each of them consisting of two ORs. The aim of the study is to evaluate the impact of different policies of opening times on the hospital Key Performance Indicators (KPIs) of interest. The results show a relevant improvement of the ORs usage of the case study.

P084: Waiting makes me sick: is it time for formal triage in primary care?

Introduction: Patient morbidity and mortality are influenced by delay in access to care and lack of continuity of care. Patients frequently present to the emergency department (ED) for care despite being registered with a primary care (PC) provider. Advanced access is an open scheduling system promoted by the College of Family Physicians of Canada that triages primary care (PC) patients to be seen within 24 hours, reducing care delay. We wished to determine the prevalence of formal triage systems in PC appointment allocation. Methods: We performed linked cross sectional surveys to quantify the number of ambulatory patients presenting to a tertiary urban ED (with an annual census of 56,000 visits) who felt unable to access primary care. PC practices were also surveyed to assess use of formal triage methods and measure access using the metric of time to third next available appointment. Descriptive statistics were calculated. Results: In the patient survey, 381 of 580 patients consented to participate. Of those, 324 patients reported reasons for their ED visit. Perception that wait time for PC was “too long” was reported in 73/324 (23%); 86% reported wait times of greater than 48 hours. The PC practice response rate was 63.8% (46/ 72). The mean time to third next available appointment was 7.7 (95% CI 4.9-10.5) days (median 5 days, range 0-50 days). No PC practice reported utilizing a formal triage system when booking appointments. Conclusion: No primary care practices in the surveyed region used a formal triage system to allocate appointments, despite a range of wait times that extended up to 50 days. The safety of primary care appointment allocation may be improved with introduction of a formal triage system, especially if overall wait times cannot be reduced.