Improving Operations Rooms planning to

reduce surgery cancellations and inpatient

length of stay
Project Identification
Problem Description
The main problems at the hospital were the high surgery cancellation rate and excessive length of stay (LOS);
The main reason for cancellations is a shortage of beds in the ICU
In the current policy, surgical procedures requiring postoperative admission to the ICU are scheduled without
information about expected patient discharges from the ICU.

Objectives
Propose changes the booking process in order to achieve a better surgery planning policy for the hospital;
Identify how the bookings would be more in line with the available ICU capacity;
Evaluate the proposed changes for surgical procedures requiring post-operative admission to the ICU
Investigate the impact of the suggested changes LOS and surgery cancellation rate.

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Materials and Methods
The case studied is a Brazilian public hospital that was set up to carry out medium- and high-
complexity surgery
Mean capacity of 350 admissions per month
Total of 145 beds as well as an ICU with 18 beds.
The data were taken from the hospital electronic medical records (EMR)
Information was collected about patient admissions, operations, internal transfers, surgery scheduling,
reasons for surgery cancellations over the year of 2014.

We used Process Modeling, Monte Carlo Simulation and Discrete Event Simulation (DES) to identify
opportunities for improving the surgery planning process.

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Results
Analysis of the processes modeled revealed various areas where there was scope for improvement
The number of surgery cancellations can be reduced by around 20%.
With the Monte Carlo Simulation it was possible to suggest a better booking policy
The idea is imposing a daily limit on the number of surgical procedures for surgeries requiring postoperative
admission to the ICU -> 6 surgeries bookings per day

Simulated More patients can be treated in the hospital:

Actual six scheduled procedures %
Variable analyzed
(days) requiring ICU Reduced Neurologic and orthopedic procedures can be
(days) increased by 30 %;
Overall LOS 7.0 2.7 61% Number of vascular procedures can be
LOS for neurologic procedures 10.6 2.0 81%
increased by 10 %;
Potential increase of 19 % in the overall
LOS for orthopedic procedures 5.1 2.8 44%
number of procedures.
LOS for vascular procedures 6.5 3.1 53%