Trade-offs in operating room planning for electives and emergencies: A review

The planning of the operating rooms (ORs) is a difficult process due to the different stakeholders involved. The real complexity, however, results from various sources of variability. This variability cannot be ignored since it greatly influences the trade-offs between the hospital costs and the patient waiting times. As a result, a need for policies guiding the OR manager in handling the trade-offs arises. Therefore, researchers have investigated different possibilities to incorporate non-elective patients in the schedule with the goal of maximizing both patient- and hospital-related measures. This paper reviews the literature on OR planning where both elective and non-elective patient categories are involved. It shows the various policies, the differences and similarities in the research settings and the resulting outcomes, whether they are beneficial or not. We find that the dedicated and the flexible policy are mostly pursued, but the setting and the assumptions of the reviewed papers vary widely. Decisions on both operational policies as well as on capacity are required to assure timely access and efficiency, which are the two main drivers for the problem at hand. Furthermore, the policy choice impacts the number of schedule disruptions and the OR utilization. However, results on the overtime and the patient waiting time are partly contradicting. The review shows that some policies have already received considerable attention, but the question of which policies are most appropriate is not yet fully answered. Neither has the full spectrum of policies been explored. The paper also addresses the remaining challenges for research in this field.