OR Spectrum

, Volume 36, Issue 3, pp 585–605 | Cite as

Reducing the number of required beds by rearranging the OR-schedule

  • J. Theresia van EssenEmail author
  • Joël M. Bosch
  • Erwin W. Hans
  • Mark van Houdenhoven
  • Johann L. Hurink
Regular Article


After surgery most of the surgical patients have to be admitted in a ward in the hospital. Due to financial reasons and a decreasing number of available nurses in the Netherlands over the years, it is important to reduce the bed usage as much as possible. One possible way to achieve this is to create an operating room (OR) schedule that spreads the usage of beds nicely over time, and thereby minimizes the number of required beds. An OR-schedule is given by an assignment of OR-blocks to specific days in the planning horizon and has to fulfill several resource constraints. Due to the stochastic nature of the length of stay of patients, the analytic calculation of the number of required beds for a given OR-schedule is a complex task involving the convolution of discrete distributions. In this paper, two approaches to deal with this complexity are presented. First, a heuristic approach based on local search is given that takes into account the detailed formulation of the objective. A second approach reduces the complexity by simplifying the objective function. This allows modeling and solving the resulting problem as an ILP. Both approaches are tested on data provided by Hagaziekenhuis in the Netherlands. Furthermore, several what-if scenarios are evaluated. The computational results show that the approach that uses the simplified objective function provides better solutions to the original problem for instances based on the situation in HagaZiekenhuis. By using this approach, the number of required beds for the considered instance of HagaZiekenhuis can be reduced by almost 20 %.


Operating room scheduling Ward occupancy Simulated annealing Integer programming 



This research is supported by the Dutch Technology Foundation STW, applied science division of NWO and the Technology Program of the Ministry of Economic Affairs. Furthermore, we would like to thank the anonymous referees for their useful comments which helped to improve the paper.


  1. Adan I, Bekkers J, Dellaert N, Vissers J, Yu X (2009) Patient mix optimisation and stochastic resource requirements: a case study in cardiothoracic surgery planning. Health Care Manag Sci 12(2):129–141CrossRefGoogle Scholar
  2. Adan I, Bekkers J, Dellaert N, Jeunet J, Vissers J (2011) Improving operational effectiveness of tactical master plans for emergency and elective patients under stochastic demand and capacitated resources. Eur J Oper Res 213(1):290–308CrossRefGoogle Scholar
  3. Bekker R, Koeleman PM (2011) Scheduling admissions and reducing variability in bed demand. Health Care Manag Sci 14(3):237–249CrossRefGoogle Scholar
  4. Beliën J, Demeulemeester E (2007) Building cyclic master surgery schedules with leveled resulting bed occupancy. Eur J Oper Res 176(2):1185–1204CrossRefGoogle Scholar
  5. Beliën J, Demeulemeester E, Cardoen B (2009) A decision support system for cyclic master surgery scheduling with multiple objectives. J Sched 12(2):147–161CrossRefGoogle Scholar
  6. Cardoen B, Demeulemeester E, Beliën J (2009) Optimizing a multiple objective surgical case sequencing problem. Int J Prod Econ 119(2):354–366CrossRefGoogle Scholar
  7. Cardoen B, Demeulemeester E, Beliën J (2009) Sequencing surgical cases in a day-care environment: an exact branch-and-price approach. Comput Oper Res 36(9):2660–2669CrossRefGoogle Scholar
  8. Cardoen B, Demeulemeester E, Beliën J (2010) Operating room planning and scheduling: a literature review. Eur J Oper Res 201(3):921–932CrossRefGoogle Scholar
  9. Chow VS, Puterman ML, Salehirad N, Huang W, Atkins D (2011) Reducing surgical ward congestion through improved surgical scheduling and uncapacitated simulation. Prod Oper Manag 20(3):418–430CrossRefGoogle Scholar
  10. Fei H, Meskens N, Chu C (2010) A planning and scheduling problem for an operating theatre using an open scheduling strategy. Comput Ind Eng 58(2):221–230CrossRefGoogle Scholar
  11. Garey MR, Johnson DS (1979) Computers and intractability: a guide to the theory of NP-completeness. W. H. Freeman & Co Ltd, San FranciscoGoogle Scholar
  12. Hulshof PJH, Boucherie RJ, van Essen JT, Hans EW, Hurink JL, Kortbeek N, Litvak N, Vanberkel PT, van der Veen E, Veltman B, Vliegen IMH, Zonderland ME (2011) Orchestra: an online reference database of or/ms literature in health care. Health Care Manag Sci 14(4):383–384Google Scholar
  13. Kirkpatrick S, Gelatt CD, Vecchi MP (1983) Optimization by simulated annealing. Science 220(4598): 671–680CrossRefGoogle Scholar
  14. van Houdenhoven M, van Oostrum JM, Wullink G, Hans E, Hurink JL, Bakker J, Kazemier G (2008) Fewer intensive care unit refusals and a higher capacity utilization by using a cyclic surgical case schedule. J Crit Care 23(2):222–226CrossRefGoogle Scholar
  15. van Oostrum JM, van Houdenhoven M, Hurink JL, Hans EW, Wullink G, Kazemier G (2008) A master surgical scheduling approach for cyclic scheduling in operating room departments. OR Spectr 30(2): 355–374Google Scholar
  16. Vanberkel PT, Boucherie RJ, Hans EW, Hurink JL, van Lent WAM, van Harten WH (2011) Accounting for inpatient wards when developing master surgical schedules. Anesth Analg 112(6):1472–1479CrossRefGoogle Scholar
  17. Vanberkel PT, Boucherie RJ, Hans EW, Hurink JL, van Lent WAM, van Harten WH (2011) An exact approach for relating recovering surgical patient workload to the master surgical schedule. J Oper Res Soc 62(10):1851–1860CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • J. Theresia van Essen
    • 1
    • 2
    Email author
  • Joël M. Bosch
    • 1
    • 2
  • Erwin W. Hans
    • 1
  • Mark van Houdenhoven
    • 2
  • Johann L. Hurink
    • 1
  1. 1.Center of Healthcare Operations Improvement and Research (CHOIR)University of TwenteEnschedeThe Netherlands
  2. 2.HagaZiekenhuisDen HaagThe Netherlands

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