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SHS_ASQ 2010 Conference: Poster The Use of Simulation for Surgical Expansion Capacity Planning
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The use of predictive simulation modeling for surgical capacity expansion analysis Alexander Kolker, PhD 1 , Mary O’Connor, RN, MSN, MBA 2 , Brett Norell, MHA/MPH, FACHE 2 , Keith Oldham, MD 3 , George Hoffman, MD 4 Outcomes Department, Children’s Hospital and Health System, Milwaukee, Wisconsin; 1 Surgical Services, Children’s Hospital of Wisconsin, Milwaukee, Wisconsin; 2 Surgery/Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin; 3 Anesthesiology/Clinical/Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin 4 Problem Statement • Children’s Hospital of Wisconsin has maximized the capacity of its current operating rooms. As a result, the organization is in the planning stages for a major facility renovation of its surgical suite to increase capacity and efficiency of surgical services. • Practically important issues that arise with a renovation for capacity expansion are: Is the designed number of general and specialized operating rooms and pre/post operative beds adequate to meet the projected patient flow and volume increases through 2013? If the design does not meet the need, how many operating rooms and pre/post operative beds would be needed? Maintain a high level of quality and satisfaction standards for surgical services utilizing predictive analysis provided by application of Management Engineering (ME) methodology. * * * * * * * * * * * Operating Rooms OpR – General; Neuro – Neurology; Ortho – Orthopedic; U – Urgent; CV – Cardiovascular; Cath – Catheterization Lab; SPR – Special Procedure Room; PACU – Post-Anesthesia Care Unit. • Model 3 should be selected as the optimal. • Cath Lab could become an issue by 2013 with more than 10% of patients waiting longer than acceptable limit of 2 hours. • All other performance criteria will be met. The following computer simulation models were developed and analyzed: Model 1 Baseline operations – all surgical services function as currently specified between two floors. Construct two general operating rooms onto upper level floor to serve otolaryngology, gastroenterology and pulmonary patient volume from lower level floor. Model 2 Move gastroenterology and pulmonary patient volume from upper level to a separate service area. Model 3 Separate service area for gastroenterology and pulmonary patient volume that includes 2 to 3 special procedure rooms and 8 to 11 preoperative beds and PACU beds. Total annual patient volume included in the simulation models is in the range from 15,000 to 17,000. Decision variables were: The number of preoperative beds and PACU beds, number of operating rooms and special procedure rooms, and their allocation for surgical services. The following performance criteria were established for the developed ME models: • Patient delay to be admitted to a preoperative surgical bed should not exceed 15 minutes. • Delay to enter operating room from a preoperative surgical bed should not exceed: General OR – 2 hours Urgent OR – 3 hours Cardiovascular OR – 5 hours Neurosurgery OR – 3 hours Orthopedic OR – 2 hours Cardiac Cath Lab – 2 hours • Percent of patients waiting longer than the acceptable delay to enter operating room from a preoperative surgical bed should not exceed 5 %. • Delay to enter PACU beds from an operating room should not exceed 5 minutes. • Average annual utilization of operating rooms should be in the range of 60% to There are three basic components that should be accounted for in this type of problem: • The number of patients (or, generally, any items) entering the system at any point of time. • The number of patients (any items) leaving the system at any point of time after spending some time in the system. • Limited capacity of the system which limits the flow of patients through the system. • All three components affect the flow of patients that the system can handle. A lack of the proper balance between these components results in system over-flow, bottlenecks, or under utilization. • Long CV surgery times create a bottleneck. • More capacity is needed to accommodate the frequency of occurrence of surgeries greater than 6 hours. Surgery Time Distribution for CV Patients Surgery time takes more than 6 hrs Simulation Model Layout (Scenarios 1 - 3) • Surgery time takes more than 6 hours (up to 16 hours) for about half of CV patients. Background Key Points Patient throughput flow represents a dynamic supply and demand balance problem. This is not a one-time snapshot. Most systems’ behavior depends on time. • Process Model Simulation methodology provides the only means of quantitative analysis of the proper balance and dynamic variability in complex systems. Conclusions Projected return on investment is 7% over the next 15 year period and positive cash flow in year one. Off Note
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SHS_ASQ 2010 Conference. Poster Session.
Transcript of SHS_ASQ 2010 Conference: Poster The Use of Simulation for Surgical Expansion Capacity Planning
The use of predictive simulation modeling for surgical capacity expansion analysis
Alexander Kolker, PhD1, Mary O’Connor, RN, MSN, MBA2, Brett Norell, MHA/MPH, FACHE2, Keith Oldham, MD3, George Hoffman, MD4
Outcomes Department, Children’s Hospital and Health System, Milwaukee, Wisconsin;1 Surgical Services, Children’s Hospital of Wisconsin, Milwaukee, Wisconsin; 2 Surgery/Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin; 3 Anesthesiology/Clinical/Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin 4
Problem Statement
• Children’s Hospital of Wisconsin has maximized the capacity of its current operating rooms. As a result, the organization is in the planning stages for a major facility renovation of its surgical suite to increase capacity and efficiency of surgical services.
• Practically important issues that arise with a renovation for capacity expansion are:
Is the designed number of general and specialized operating rooms and pre/post operative beds adequate to meet the projected patient flow and volume increases through 2013?
If the design does not meet the need, how many operating rooms and pre/post operative beds would be needed?
Maintain a high level of quality and satisfaction standards for surgical services utilizing predictive analysis provided by application of Management Engineering (ME) methodology.
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Operating Rooms
OpR – General; Neuro – Neurology; Ortho – Orthopedic; U – Urgent; CV – Cardiovascular; Cath – Catheterization Lab; SPR – Special Procedure Room; PACU – Post-Anesthesia Care Unit.
• Model 3 should be selected as the optimal.
• Cath Lab could become an issue by 2013 with more than 10% of patients waiting longer than acceptable limit of 2 hours.
• All other performance criteria will be met.
The following computer simulation models were developed and analyzed:
Model 1 Baseline operations – all surgical services function as currently specified between two floors. Construct two general operating rooms onto upper level floor to serve otolaryngology, gastroenterology and pulmonary patient volume from lower level floor.
Model 2Move gastroenterology and pulmonary patient volume from upper level to a separate service area.
Model 3 Separate service area for gastroenterology and pulmonary patient volume that includes 2 to 3 special procedure rooms and 8 to 11 preoperative beds and PACU beds.
Total annual patient volume included in the simulation models is in the range from 15,000 to 17,000.
Decision variables were: The number of preoperative beds and PACU beds, number of operating rooms and special procedure rooms, and their allocation for surgical services.
The following performance criteria were established for the developed ME models:
• Patient delay to be admitted to a preoperative surgical bed should not exceed 15 minutes.
• Delay to enter operating room from a preoperative surgical bed should not exceed:
General OR – 2 hours
Urgent OR – 3 hours
Cardiovascular OR – 5 hours
Neurosurgery OR – 3 hours
Orthopedic OR – 2 hours
Cardiac Cath Lab – 2 hours
• Percent of patients waiting longer than the acceptable delay to enter operating room from a preoperative surgical bed should not exceed 5 %.
• Delay to enter PACU beds from an operating room should not exceed 5 minutes.
• Average annual utilization of operating rooms should be in the range of 60% to 90%.
There are three basic components that should be accounted for in this type of problem:
• The number of patients (or, generally, any items) entering the system at any point of time.
• The number of patients (any items) leaving the system at any point of time after spending some time in the system.
• Limited capacity of the system which limits the flow of patients through the system.
• All three components affect the flow of patients that the system can handle.
A lack of the proper balance between these components results in system over-flow, bottlenecks, or under utilization.
• Long CV surgery times create a bottleneck.
• More capacity is needed to accommodate the frequency of occurrence of surgeries greater than 6 hours.
Surgery Time Distribution for CV Patients
Surgery time takes
more than 6 hrs
Simulation Model Layout (Scenarios 1 - 3)
• Surgery time takes more than 6 hours (up to 16 hours) for about half of CV patients.
Background
Key Points
Patient throughput flow represents a dynamic supply and demand balance problem. This is not a one-time snapshot. Most systems’ behavior depends on time.
• Process Model Simulation methodology provides the only means of quantitative analysis of the proper balance and dynamic variability in complex systems.
Conclusions
Projected return on investment is 7% over the next 15 year period and positive cash flow in year one.
Off Note
