Performance analysis and scheduling strategies for ambulatory surgical facilities
type: CreativeWork
description: Ambulatory surgery is a procedure that does not require an overnight hospital stay and is cost effective and efficient. The goal of this research is to develop an ASF operational model which allows management to make key decisions. This research develops and utilizes the simulation software ARENA based model to accommodate: (a) Time related uncertainties -- Three system uncertainties characterize the problem (ii) Surgery time variance (ii) Physician arrival delay and (iii) Patient arrival delay; (b) Resource Capture Complexities -- Patient flows vary significantly and capture/utilize both staffing and/or physical resources at different points and varying levels; and (c) Processing Time Differences -- Patient care activities and surgical operation times vary by type and have a high level of variance between patient acuity within the same surgery type. A multi-dimensional ASF non-clinical performance objective is formulated and includes: (i) Fixed Labor Costs -- regular time staffing costs for two nurse groups and medical/tech assistants, (i i) Overtime Labor Costs -- staffing costs beyond the regular schedule, (i i i) Patient Delay Penalty -- Imputed costs of waiting time experienced patients, and (iv) Physician Delay Penalty -- Imputed costs of physicians having to delay surgical procedures due to ASF causes (limited staffing, patient delays, blocked OR, etc.). Three ASF decision problems are studied: (i) Optimize Staffing Resources Levels - Variations in staffing levels though are inversely related to patient waiting times and physician delays. The decision variable is the number of staff for three resource groups, for a given physician assignment and surgery profile. The results show that the decision space is convex, but decision robustness varies by problem type. For the problems studied the optimal levels provided 9% to 28% improvements relative to the baseline staffing level. The convergence rate is highest for less than optimal levels of Nurse-A. The problem …
abstract: Ambulatory surgery is a procedure that does not require an overnight hospital stay and is cost effective and efficient. The goal of this research is to develop an ASF operational model which allows management to make key decisions. This research develops and utilizes the simulation software ARENA based model to accommodate: (a) Time related uncertainties -- Three system uncertainties characterize the problem (ii) Surgery time variance (ii) Physician arrival delay and (iii) Patient arrival delay; (b) Resource Capture Complexities -- Patient flows vary significantly and capture/utilize both staffing and/or physical resources at different points and varying levels; and (c) Processing Time Differences -- Patient care activities and surgical operation times vary by type and have a high level of variance between patient acuity within the same surgery type. A multi-dimensional ASF non-clinical performance objective is formulated and includes: (i) Fixed Labor Costs -- regular time staffing costs for two nurse groups and medical/tech assistants, (i i) Overtime Labor Costs -- staffing costs beyond the regular schedule, (i i i) Patient Delay Penalty -- Imputed costs of waiting time experienced patients, and (iv) Physician Delay Penalty -- Imputed costs of physicians having to delay surgical procedures due to ASF causes (limited staffing, patient delays, blocked OR, etc.). Three ASF decision problems are studied: (i) Optimize Staffing Resources Levels - Variations in staffing levels though are inversely related to patient waiting times and physician delays. The decision variable is the number of staff for three resource groups, for a given physician assignment and surgery profile. The results show that the decision space is convex, but decision robustness varies by problem type. For the problems studied the optimal levels provided 9% to 28% improvements relative to the baseline staffing level. The convergence rate is highest for less than optimal levels of Nurse-A. The problem …
author: Zhang, Xuanqi
keywords: Ambulatory surgical facilities, Discrete-event simulation, Mixed integer programming, Linear programming, Classical flow shop sequence, Optimization, Industrial Engineering
date published: 2014-01-31T08:00:00Z
date modified: 2026-07-24T03:22:01Z
provider: NJIT
publisher: Networked Digital Library of Theses and Dissertations
type: WebPage
source organization: NJIT