Operating Room Scheduling With Re-entrant Patient Flow

With the increasing emphasis on medical care in China,the medical market in China has seen the problem of large hospitals being overcrowded and the resources of small and medium-sized hospitals being idle.The contradiction between the limited supply of medical resources and the expanded demand of medical services needs to be resolved.Since the new medical reform,various policies have put forward higher requirements for the hospital's operation and management capabilities.The importance of efficiently allocating medical resources is self-evident.Providing more satisfactory services to patients at a lower cost has become a strong competition guarantee for hospitals to survive in the medical market.The surgical system,as the center hub of the hospital,includes resources related to surgical personnel,materials,and equipment,and is an important source of hospital revenue and expenditure.Improving the operating efficiency of the surgical system has become a key issue in reducing hospital operating costs,improving hospital comprehensive benefits,and ensuring the quality of medical services.An important way to improve the operational efficiency of surgical systems is efficient surgical scheduling.In this study,surgical planning is considered as a three-stage problem including preoperative preparation,intraoperative surgery and postoperative recovery.In this problem,bed resources are shared before and after surgery.This study considers the situation where surgical trauma and incomplete anesthetic effects may lead to the deterioration of the patient's condition,adding the constraint of not allowing waiting between the three stages to the constraint condition,and a no-wait re-entrant surgical scheduling model was constructed with the aim of minimizing the average completion time of the patients.According to the characteristics of the surgical model,a hybrid algorithm GA-IVNS integrated genetic algorithm with variable neighborhood search was designed.Six neighborhoods based on gene blocks were designed in the process of variable neighborhood search.The performance of the algorithm was compared with some competitive approaches by a set of test problems,which verifies that the GA-IVNS algorithm has better performance in solving this problem,and strategic design of neighborhood based on problem characteristics is helpful to improve the efficiency of the algorithm.In order to further increase the practicability of scheduling algorithms,the uncertain service time at each stage of surgery and the surgical needs of the elderly and young patients were considered.In the intraoperative and postoperative stages,triangular fuzzy numbers were used to describe the surgery and recovery duration.The preoperative stage considers the uncertain preparation time caused by the deteriorating effect of the elderly and young patients.A no-wait indefinite re-entrant surgical scheduling model was constructed with the aim of minimizing the average completion time of the patients,and GA-AVNS algorithm was proposed on the basis of the GA-IVNS.The algorithm not only applies the roulette rule which based on the selection probability to the transformation between neighborhoods,but also makes a strategic design of the neighborhood based on the characteristics of the new problem.Finally,the effectiveness of the algorithm is verified by experimental comparison and analysis.which illustrated that adding an adaptive neighborhood selection mechanism in the hybrid algorithm helps improve the efficiency of the algorithm.