A simulation model for perioperative process improvement

Operating rooms (ORs) are a hospital's largest cost center and greatest source of revenue. Surgical delays and cancellations lead to staff dissatisfaction due to long working hours, patient anxiety from long wait time, and extra costs for staff overtime. A discrete event simulation was used to model the perioperative process in the general surgery service at Toronto General Hospital, aiming to reduce the number of surgical cancellations and thereby improve the overall process. This model considers emergency case interruptions with different levels of urgency and takes into account the availability of five types of post-surgical beds. The effects of three scenarios on the number of surgical cancellations were examined: (1) scheduling the surgeons based on their patients usage length of post-surgical beds, (2) sequencing surgical procedures by length and variance, and (3) increasing the number of post-surgical beds. The results indicate that scheduling the surgeons in a weekly schedule based on the patients' average length of stay in the ward, sequencing surgeries in order of increasing length and variance, and adding beds to the surgical ward all reduced the number of surgical cancellations, both individually and collectively. The interactions of all of these scenarios were compared against the current system and against each other to provide a basis for future OR planning and scheduling.