Reducing surgical ward congestion at the vancouver island health authority through improved surgical scheduling

As a consequence of high surgical bed occupancy levels in Vancouver Island Health Authority (VIHA) hospitals, staff stress levels, surgical cancellations and wait times for surgeries were becoming problematic. In collaboration with VIHA management and through site visits, interviews, and data analyses, we found that this congestion was in part attributable to current surgical scheduling practices which focussed on efficient use of the operating rooms but ignored the downstream bed utilization patterns caused by these schedules. We developed two tools, the Bed Utilization Simulator (BUS) and the Surgical Scheduling Optimizer (SSO) to improve current scheduling practices. BUS is a Monte Carlo simulation model written in Visual Basic for Applications in MS Excel that predicts inpatient bed utilization patterns for a specified surgical schedule entered through a graphical interface. This highly portable model imports historical patient records from hospital information systems to accurately represent historical patient mix when assessing schedules. SSO is a mixed integer programming model developed to provide schedules, as well as scheduling principles, that achieve minimal day to day variation in ward occupancy. Surgical planners could then use BUS to assess and revise these schedules, to account for factors not captured in SSO. These tools have been used on a “What if? ” basis t