title: Managing daily surgery schedules in a teaching hospital: a mixed-integer optimization approach.
abstract: BACKGROUND
  This study examined the daily surgical scheduling problem in a teaching hospital. This problem relates to the use of multiple operating rooms and different types of surgeons in a typical surgical day with deterministic operation durations (preincision, incision, and postincision times). Teaching hospitals play a key role in the health-care system; however, existing models assume that the duration of surgery is independent of the surgeon's skills. This problem has not been properly addressed in other studies. We analyze the case of a Spanish public hospital, in which continuous pressures and budgeting reductions entail the more efficient use of resources.
  
  
  METHODS
  To obtain an optimal solution for this problem, we developed a mixed-integer programming model and user-friendly interface that facilitate the scheduling of planned operations for the following surgical day. We also implemented a simulation model to assist the evaluation of different dispatching policies for surgeries and surgeons. The typical aspects we took into account were the type of surgeon, potential overtime, idling time of surgeons, and the use of operating rooms.
  
  
  RESULTS
  It is necessary to consider the expertise of a given surgeon when formulating a schedule: such skill can decrease the probability of delays that could affect subsequent surgeries or cause cancellation of the final surgery. We obtained optimal solutions for a set of given instances, which we obtained through surgical information related to acceptable times collected from a Spanish public hospital.
  
  
  CONCLUSIONS
  We developed a computer-aided framework with a user-friendly interface for use by a surgical manager that presents a 3-D simulation of the problem. Additionally, we obtained an efficient formulation for this complex problem. However, the spread of this kind of operation research in Spanish public health hospitals will take a long time since there is a lack of knowledge of the beneficial techniques and possibilities that operational research can offer for the health-care system.
authors.affiliation: Escuela Técnica Superior de Ing, Industriales (ETSII-UPM), José Gutierrez Abascal 2, 28006 Madrid, Spain. raul.pulido@upm.es.
authors.forename: Raul
authors.initials: R
authors.lastname: Pulido
authors.forename: Adrian M
authors.initials: AM
authors.lastname: Aguirre
authors.forename: Miguel
authors.initials: M
authors.lastname: Ortega-Mier
authors.forename: Álvaro
authors.initials: Á
authors.lastname: García-Sánchez
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Méndez
mesh_terms: D001071:Appointments and Schedules; D003198:Computer Simulation; D003365:Costs and Cost Analysis; D003657:Decision Making; D017598:Efficiency, Organizational; D006302:Health Services Research; D006784:Hospitals, Teaching / Q000458:organization & administration*; D006801:Humans; D015233:Models, Statistical; D009873:Operating Rooms / Q000706:statistics & numerical data*; D013030:Spain; D017748:Time Management