The real time management of operating rooms

At the operational decision level, the problem arising in the Operating Room (OR) planning is also called “surgery process scheduling”, which usually consists in selecting elective patients from a waiting list and assigning them to a specific operating room on a specific day, and determining the sequence of surgical procedures and the allocation of resources for each OR session. The Real Time Management (RTM) of operating rooms is the decision problem arising during the fulfillment of the surgery process scheduling, that is the problem of supervising the execution of such a schedule and, in case of delays, to take the more rational decision regarding the surgery cancellation or the overtime assignment. The RTM is characterized by the uncertainty of its main parameters, that is, for instance, the duration of a surgery and the arrivals of non-elective patients. In this chapter we propose online optimization approaches for the RTM capable to deal with (1) the elective and non-elective patient flows within a single surgical pathway (Non-Elective Worst Fit algorithm), and with (2) the resource sharing among different surgical pathways of elective patients (Flexible Overtime Allocation and Flexible Scheduling policies). We assess the effectiveness of the proposed solutions on simulated surgical clinical pathways under several scenarios. From a methodological point of view, our analysis suggested that online optimization can be a suitable methodology to deal with the inherent stochastic aspects arising in the majority of the health care problems.