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Public hospitals are non-profit organizations,

and their prime operational objective is to
provide medical services to their patients at a
reasonable cost. In such an environment, a
significant amount of time and resources are
invested in operating theatres. If optimum
allocation strategies are devised for the same,
worthy savings can be achieved.

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 Priority for Surgery:
1. Emergency Patients
2. Inpatients
3. Outpatients
 Separate Operating Rooms for Emergency cases.
 Emergency Operating rooms are equipped so that it can handle all
kinds of surgeries.
 Non-Emergency Operating rooms are separate for each specialty.
 Emergency cases can be done in Non-Emergency rooms but vice-
versa is not possible.
 Only one operating room is used for emergency surgeries each day.

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 No of working days per week is 5 with 8 staffed hours per day.
 No overloads.
 Demand pattern is known before hand.
 The model does not account for uncertainty in demand.
 The surgery demand is measured by the amount of operating room
hours.
 All Emergency surgery demand must be met on the day it arises.
 Non-Emergency or Inpatient’s and outpatient’s surgery can be
delayed.
 Postponed Non-Emergency surgery must be met within 7 days.

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• I: Set of Room types.
• J: Set of Medical specialties.
• D: Set of Days.
• i: Index for Room type.
• j: Index for specialty.
• k, l: Indices for days.
• s: amount of staffed hours per day.
• ai: Number of operating rooms of type i.
• ejk: Emergency patient’s surgery demand for specialty j on day k (hours).
• Ojk: Non-Emergency patient’s surgery demand for specialty j on day k (hours).
• ρkl: Number of days delayed if the surgery is postponed from day k to day l.
• Θ: The equivalent number of days delayed if some surgery demand is not met in the
model.
• β : Penalty rate for undersupply of OR hours to a specialty. It serves the purpose of
smoothing the OR capacity. Value is <1.

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• xijk: Number of Operating Rooms of type i allocated to specialty j on
day k.
• yjk: Amount of Emergency OR’s staffed hours allocated to specialty j on
day k.
• zjkl: Specialty j’s non-emergency demand postponed from day k to day l.
• ujk: Specialty j’s unmet non-emergency demand on day k.
• bjk: Amount of idle time of the OR allocated to specialty j on day k.
• h: Total amount of idle time of all non-emergency OR’s.
• qj: Undersupply of OR hours to specialty j relative to its desired level.

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 Minimize
(𝜌𝑘𝑙 𝑧𝑗𝑘𝑙) + 𝜃 𝑢𝑗𝑘 + 𝛽 𝑞𝑗
𝑘𝜖𝐷 𝑙∈𝐷 𝑗∈𝐽 𝑗∈𝐽 𝑘∈𝐷 𝑗∈𝐽

Total Penalty caused by Undersupply of

OR hours for each specialty.
Unmet non-emergency demand on day k.

Patients length of stay caused by the delay in meeting

surgery demand within specified day.

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 𝑥𝑖𝑗𝑘 = 𝑎𝑖 ∀𝑖, 𝑘
𝑗∈𝐽

Guarantees that all the operating rooms are allocated to

some specialty each day.

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 𝑠 𝑥𝑖𝑗𝑘 ≥ 𝑒𝑗𝑘 − 𝑦𝑗𝑘 + 𝑧𝑗𝑙𝑘 ∀𝑗, 𝑘
𝑖∈𝐼 𝑙∈𝐷

Ensures that on any day, each specialty has at least the OR capacity
to meet the sum of its emergency demand on that day and non-
emergency demand decided to be postponed to that day.

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 𝑠 𝑥𝑖𝑗𝑘 − (𝑒𝑗𝑘 − 𝑦𝑗𝑘 + 𝑧𝑗𝑙𝑘) − 𝑏𝑗𝑘 + 𝑧𝑗𝑙𝑘 + 𝑢𝑗𝑘 = 𝑜𝑗𝑘 ∀𝑗, 𝑘
𝑖∈𝐼 𝑙∈𝐷 𝑙∈𝐷

Specialty j’s non-emergency surgery demand on day k must met

either on that day, some remaining day in the current week, or
unmet (that is met 𝜃 days late).

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 ℎ= 𝑏𝑗𝑘
𝑗∈𝐽 𝑘∈𝐷

Defines h as the sum of idle hours of all the non-emergency ORs over
one week.

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 𝑦𝑗𝑘 ≤ 𝑠 ∀𝑘
𝑗∈𝐽

Guarantees that at most s hours of emergency demand is

met in the emergency OR each day.

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 𝑦𝑗𝑘 ≤ 𝑒𝑗𝑘 ∀𝑗, 𝑘

Guarantees the daily emergency OR capacity

allocated to each specialty does not exceed their
emergency demand.

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 𝑥𝑖𝑗𝑘, 𝑦𝑗𝑘, 𝑧𝑗𝑘𝑙, 𝑢𝑗𝑘, 𝑏𝑗𝑘, ℎ ≥ 0, ∀𝑖, 𝑗, 𝑘, 𝑙

Non-Negativity constraint in all the decision variables.

𝑥𝑖𝑗𝑘 integer, ∀𝑖, 𝑗, 𝑘

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After obtaining the template from the MIP
model, a simulation model is used to assess
the quality of the template generated by MIP.

The optimum 𝛽 value can be determined by

testing the template in the simulation model.

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 Each specialty has two queues waiting for the surgery: Inpatients and
Outpatients.
 There is a single queue for all emergency patients who need surgery.
 All Operating Rooms are modeled as servers in the queue system.
 The number of Non-Emergency Operating Rooms available to each
specialty changes throughout the week as determined by the template.
 All types of patient arrivals are modeled as renewal processes.
 Pre-surgery set-up time and post-surgery operating room cleaning
time, if significant, is also added to the model.
 Each specialty’s inpatient, outpatient, and emergency patient’s surgery
lengths are random variables fit from historical data.

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Hospital: Los Angeles County General Hospital.

Operating Rooms: 19.

Specialties: 18.

Emergency Operating Rooms: 1.

Data used: January 2005.

Values of smoothing constant(𝛽) : 0, 0.5, 0.75, 1.

Softwares used: CPLEX 9.0(Solver), AweSim! Version 3(Simulation).

Computer Hardware used: 3.2 GHz CPU with 2GB RAM.

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 Unit: OR hour Template i Template ii Template iii Template iv Template v
40 40 40 40 40
OPERATING ROOM CAPACITY ALLOCATED TO EACH SPECIALTY PER WEEK
Emergency

Burns 32 32 32 32 24
Cardiac 48 40 40 40 40
Colorectal 24 40 32 24 24
Foregut 16 16 16 16 16
Template iii: 𝛽 = 0.5
Template v: 𝛽 = 1

HNS 88 80 88 88 88
Neuro 40 40 40 40 40
Ortho 192 160 168 176 184
Trauma 8 24 24 24 24
Tumor 24 24 24 24 24
40 40 40 40 40
Template i: Actual Allocation

Urology

GSNTE 16 40 40 40 40
Template iv: 𝛽 = 0.75

Plastics 24 24 24 24 24
Template ii: 𝛽 = 0

Hepatobiliary 24 24 24 24 24
Ophthalmology 80 72 72 72 72
OMFS 32 32 32 32 32
Vascular 24 32 24 24 24
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 Template ii iii iv v
𝛽 0 0.5 0.75 1
Patient’s Average Wait (Day) 1.64 1.81 1.90 1

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 Template i v
Emergency Patients Average Wait(day) 0.62 0.51
Emergency Operating Room Utilization(%) 48.35 47.28
Inpatients Average Wait(day) 1.86 1.54
Outpatients Average Wait(day) 0.34 0.33
Average Non-Emergency Operating Room Utilization(%) 63.39 65.91

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 𝑂𝑗𝑘 + 𝑍𝑖𝑗𝑘 − 𝑢𝑗𝑘 ≤ 𝑃𝑂𝐶 ℎ𝑜𝑢𝑟𝑠 ∀ 𝑗, 𝑘
𝑖∈𝐼

The sum of the total non-emergency demand and the

demand that has been postponed to day k from l
minus the non emergency demand that has been
postponed from day k for a specialty j must be less
than or equal to the number of hours available on
post-operative care.

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