Assessing the impact of patient prioritization on operating room schedules

Résumé 0

This paper proposes an integrated approach to merge patient prioritization and patient schedulingto improve access to services in an elective (i.e., non-urgent) context. In particular, we assume thatpatients are included on a waiting list for a given surgery, and that every patient on the list hasreceived a ‘‘utility score’’, which is aproxyfor the relative urgency with regards to the other patientson the list. A mathematical model is formulated to solve the patient scheduling problem, i.e., thesimultaneous assignment of surgery sessions to surgeons and patients to surgeons, in such a way thatthe total utility is maximized along with other practical requirements. The model has been appliedto a testbed of randomly generated instances, inspired by the context of the Urology Department ata University Hospital in Quebec City. Experiments have been conducted to analyze both the short-and medium-term behaviors of the proposed approach. The numerical results confirm that the use ofan objective function designed to maximize utility does not deteriorate the efficiency of the resultingschedules in terms of the number of surgeries performed. They also show that, as expected, higherutility patients are scheduled first, and their waiting time before surgery are shorter than those oflower utility. However, this approach may lead to longer, and even unacceptable waiting times forlow utility patients. To mitigate such an undesirable effect, a dynamic utility updating approach isproposed to progressively increase the utility of patients according to their time spent on the waitinglist. This approach seems to adequately balance the advantages of scheduling patients based on theirutility and the risk of causing too much delay for low priority patients.