Strategic placement of volunteer responder system defibrillators.

Volunteer responder systems (VRS) alert and guide nearby lay rescuers towards the location of an emergency. An application of such a system is to out-of-hospital cardiac arrests, where early cardiopulmonary resuscitation (CPR) and defibrillation with an automated external defibrillator (AED) are crucial for improving survival rates. However, many AEDs remain underutilized due to poor location choices, while other areas lack adequate AED coverage.

Radiotherapy treatment scheduling: Implementing operations research into clinical practice.

Background: Every week, radiotherapy centers face the complex task of scheduling hundreds of treatment sessions amongst the available linear accelerators. With the increase in cancer patient numbers, manually creating a feasible and efficient schedule has shown to be a difficult, time-consuming task. Although operations research models have been increasingly reported upon to optimize patient care logistics, there is almost no scientific evidence of implementation in practice.

Radiotherapy treatment scheduling considering time window preferences.

External-beam radiotherapy treatments are delivered by a linear accelerator (linac) in a series of high-energy radiation sessions over multiple days. With the increase in the incidence of cancer and the use of radiotherapy (RT), the problem of automatically scheduling RT sessions while satisfying patient preferences regarding the time of their appointments becomes increasingly relevant. While most literature focuses on timeliness of treatments, several Dutch RT centers have expressed their need to include patient preferences when scheduling appointments for irradiation sessions.

Improving workflow control in radiotherapy using discrete-event simulation.

Background: In radiotherapy, minimizing the time between referral and start of treatment (waiting time) is important to possibly mitigate tumor growth and avoid psychological distress in cancer patients. Radiotherapy pre-treatment workflow is driven by the scheduling of the first irradiation session, which is usually set right after consultation (pull strategy) or can alternatively be set after the pre-treatment workflow has been completed (push strategy). The objective of this study is to assess the impact of using pull and push strategies and explore alternative interventions for improving timeliness in radiotherapy.

Operations research for resource planning and -use in radiotherapy: a literature review.

Background: The delivery of radiotherapy (RT) involves the use of rather expensive resources and multi-disciplinary staff. As the number of cancer patients receiving RT increases, timely delivery becomes increasingly difficult due to the complexities related to, among others, variable patient inflow, complex patient routing, and the joint planning of multiple resources. Operations research (OR) methods have been successfully applied to solve many logistics problems through the development of advanced analytical models for improved decision making.

A case study of cost-efficient staffing under annualized hours.

We propose a mathematical programming formulation that incorporates annualized hours and shows to be very flexible with regard to modeling various contract types. The objective of our model is to minimize salary cost, thereby covering workforce demand, and using annualized hours. Our model is able to address various business questions regarding tactical workforce planning problems, e.

Tactical resource allocation and elective patient admission planning in care processes.

Tactical planning of resources in hospitals concerns elective patient admission planning and the intermediate term allocation of resource capacities. Its main objectives are to achieve equitable access for patients, to meet production targets/to serve the strategically agreed number of patients, and to use resources efficiently. This paper proposes a method to develop a tactical resource allocation and elective patient admission plan.

Reducing the throughput time of the diagnostic track involving CT scanning with computer simulation.

Introduction: To examine the use of computer simulation to reduce the time between the CT request and the consult in which the CT report is discussed (diagnostic track) while restricting idle time and overtime.

Methods: After a pre implementation analysis in our case study hospital, by computer simulation three scenarios were evaluated on access time, overtime and idle time of the CT; after implementation these same aspects were evaluated again. Effects on throughput time were measured for outpatient short-term and urgent requests only.

ORchestra: an online reference database of OR/MS literature in health care.

We introduce the categorized reference database ORchestra, which is available online at http://www.utwente.nl/choir/orchestra/.

Accounting for inpatient wards when developing master surgical schedules.

Background: As the demand for health care services increases, the need to improve patient flow between departments has likewise increased. Understanding how the master surgical schedule (MSS) affects the inpatient wards and exploiting this relationship can lead to a decrease in surgery cancellations, a more balanced workload, and an improvement in resource utilization. We modeled this relationship and used the model to evaluate and select a new MSS for a hospital.

A simulation model for determining the optimal size of emergency teams on call in the operating room at night.

Background: Hospitals that perform emergency surgery during the night (e.g., from 11:00 pm to 7:30 am) face decisions on optimal operating room (OR) staffing.

Closing emergency operating rooms improves efficiency.

Long waiting times for emergency operations increase a patient's risk of postoperative complications and morbidity. Reserving Operating Room (OR) capacity is a common technique to maximize the responsiveness of an OR in case of arrival of an emergency patient. This study determines the best way to reserve OR time for emergency surgery.

Improving operating room efficiency by applying bin-packing and portfolio techniques to surgical case scheduling.

Background: An operating room (OR) department has adopted an efficient business model and subsequently investigated how efficiency could be further improved. The aim of this study is to show the efficiency improvement of lowering organizational barriers and applying advanced mathematical techniques.

Methods: We applied advanced mathematical algorithms in combination with scenarios that model relaxation of various organizational barriers using prospectively collected data.

A norm utilisation for scarce hospital resources: evidence from operating rooms in a Dutch university hospital.

Background: Utilisation of operating rooms is high on the agenda of hospital managers and researchers. Many efforts in the area of maximising the utilisation have been focussed on finding the holy grail of 100% utilisation. The utilisation that can be realised, however, depends on the patient mix and the willingness to accept the risk of working in overtime.

Applying the variety reduction principle to management of ancillary services.

Background: As central diagnostic facilities, computer tomography (CT) scans appear to be bottlenecks in many patient-care processes. This study describes a case study concerning redesign of a CT scan department in the Academic Medical Center in Amsterdam, the Netherlands.

Purposes: The aim was to decrease access time for the CT-scan and simultaneously increase utilization level.

Influence of cardiac risk factors and medication on length of hospitalization in patients undergoing major vascular surgery.

Major vascular surgery is associated with a long in-hospital length of stay (LOS). Cardiac risk factors identify patients with an increased risk. Recent studies have associated statin, aspirin, and beta-blocker therapies with improved postoperative outcome.