Evaluation and implementation of a Just-In-Time bed-assignment strategy to reduce wait times for surgical inpatients.

Early bed assignments of elective surgical patients can be a useful planning tool for hospital staff; they provide certainty in patient placement and allow nursing staff to prepare for patients' arrivals to the unit. However, given the variability in the surgical schedule, they can also result in timing mismatches-beds remain empty while their assigned patients are still in surgery, while other ready-to-move patients are waiting for their beds to become available. In this study, we used data from four surgical units in a large academic medical center to build a discrete-event simulation with which we show how a Just-In-Time (JIT) bed assignment, in which ready-to-move patients are assigned to ready-beds, would decrease bed idle time and increase access to general care beds for all surgical patients.

Using Real-Time Locating Systems to Optimize Endoscope Use at a Large Academic Medical Center.

Massachusetts General Hospital (MGH) manages a large inventory of surgical equipment which must be delivered to operating rooms on-time, efficiently, and according to a set of quality standards and regulatory guidelines. In recent years, flexible scope management has become a topic of interest for many hospitals, as they face pressure to reduce costs, prevent infections that can result from mismanagement, and are under increased regulatory oversight. This work conducted at MGH proposes a novel method for surgical equipment management in a hospital.

Systematic OR Block Allocation at a Large Academic Medical Center: Comprehensive Review on a Data-driven Surgical Scheduling Strategy.

Objective: To alleviate the surgical patient flow congestion in the perioperative environment without additional resources.

Background: Massachusetts General Hospital experienced increasing overcrowding of the perioperative environment in 2008. The Post-Anesthesia Care Unit would often be at capacity, forcing patients to wait in the operating room.

Pooled Open Blocks Shorten Wait Times for Nonelective Surgical Cases.

Objective: Assess the impact of the implementation of a data-driven scheduling strategy that aimed to improve the access to care of nonelective surgical patients at Massachusetts General Hospital (MGH).

Background: Between July 2009 and June 2010, MGH experienced increasing throughput challenges in its perioperative environment: approximately 30% of the nonelective patients were waiting more than the prescribed amount of time to get to surgery, hampering access to care and aggravating the lack of inpatient beds.

Methods: This work describes the design and implementation of an "open block" strategy: operating room (OR) blocks were reserved for nonelective patients during regular working hours (prime time) and their management centralized.

Elective change of surgeon during the OR day has an operationally negligible impact on turnover time.

Study Objective: To compare turnover times for a series of elective cases with surgeons following themselves with turnover times for a series of previously scheduled elective procedures for which the succeeding surgeon differed from the preceding surgeon.

Design: Retrospective cohort study.

Setting: University-affiliated teaching hospital.

A model for understanding the impacts of demand and capacity on waiting time to enter a congested recovery room.

Background: When a recovery room is fully occupied, patients frequently wait in the operating room after emerging from anesthesia. The frequency and duration of such delays depend on operating room case volume, average recovery time, and recovery room capacity.

Methods: The authors developed a simple yet nontrivial queueing model to predict the dynamics among the operating and recovery rooms as a function of the number of recovery beds, surgery case volume, recovery time, and other parameters.