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Improving the surgery process of the day care department at Erasmus Medical Centre

Schrijer, S.D. (2020) Improving the surgery process of the day care department at Erasmus Medical Centre.

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Abstract:Background & Motivation: Erasmus MC is a large tertiary hospital in The Netherlands that delivers mainly specialized care. One of the departments of the hospital is the day care department. This department is used for treatments that do not require an overnight stay at the hospital. Day care surgeries are the main type of treatments that are performed via the day care department. When patients undergo surgery they have to be transported from the day care department on the fourth floor to the ORdepartment on the sixth floor and delivered at the holding at the Middle wing. Currently the hospital experiences that day care surgeries often start too late. Surgeries starting too late leads to overtime, patient cancellations and non-occupied ORs. Since ORs are one of the most expensive assets of a hospital, the late start of surgeries has a negative impact on the performance of the hospital. Therefore, this research suggests a solution to decrease the number of day care surgeries starting too late. Approach: After a practical experience at the day care department of the hospital we assumed that the amount of surgeries that start too late is the result of the distribution of patient transportations throughout the day which day care nurses cannot handle. In order to confirm this finding we investigated the current process of day care surgery. First, the current situation was analysed by making a flowchart diagram and a problem cluster. We concluded that the split-up of the holding and recovery at the OR-department resulted in increased pick-up time for day care patients since nurses have to walk through the OR-department and need to put an OR-suit on to pick up patients from the recovery at the South wing. This also increased the number of transport movements around the elevator on the Middle wing of the OR-department resulting in more congestion throughout the day. Secondly, the number of surgeries starting throughout the day was analysed. This made clear that there is a large peak of day care surgeries that are planned to start at 08:00, but often these surgeries start too late. Throughout the rest of the day repetitive peak moments of day care surgeries that start in the same timeslot were observed. Thirdly, the surgery properties are analysed by means of a case-mix classification based on the coefficient of variation and average occupancy of an OR-session per surgery type. This made clear that day care surgeries do not deviate much from their expected surgery duration and occupy relatively small parts of OR-sessions. Clinical surgeries generally deviate more from their expected value and occupy larger parts of OR-sessions. Lastly, the surgery data was analysed to investigate the current planning method. The analysis was performed by making use of an algorithm that produced per specialty the three most occurring sequences of admission types in an OR-session. This analysis - 4 - was also performed for the three most occurring sequences based on surgery length. Such a sequence represents the order in which surgeries take place in an OR-session. Since the ORdepartment did not have a clear vision of their current planning method the analysis helped to point out opportunities for improvement and served as a starting point for recommendations for the planning methods of the OR-department. Together with the analysis of the surgery process of day care patients we concluded that the transportation moments of day care patients should be better spread throughout the day. Problem-Solving Approach: The first possible solution of the problem originated from the hospital staff. Currently there are two ORs next to the day care department. Patients can be delivered much faster to these ORs than to the ones on the sixth floor. Recently, the Project Team ICM came up with a plan to add two new ORs to the ORs on the fourth floor. However, this is a long-term plan that will require a large investment. The second intervention is an adjustment of the current planning method. We introduce the concept of a “differentiated start” where not all surgeries start at the same time to spread the number of surgeries more throughout the day. Another intervention would be to take a look at the recovery time of patients to also predict the pick-up moments of patients and get a precise picture of the amount of patient transports per timeslot. In this way one can try to find a planning method that spreads the transportation as evenly as possible. We leave this intervention for further research and focus on the intervention of a differentiated start. Since such a decision can have several consequences for the OR-department we decided to test this solution and create a Monte-Carlo simulation to perform experiments with different starting times. We created a simulation model including a dashboard to manage the simulations. The simulation model can be used as a powerful management tool by the hospital and as a starting point for future research.
Item Type:Essay (Bachelor)
Faculty:BMS: Behavioural, Management and Social Sciences
Programme:Industrial Engineering and Management BSc (56994)
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