Improving operational effectiveness of tactical master plans for emergency and elective patients under stochastic demand and capacitated resources

This paper develops a two-stage planning procedure for master planning of elective and emergency patients while allocating at best the available hospital resources. Four types of resources are considered: operating theatre, beds in the medium and in the intensive care units, and nursing hours in the intensive care unit. A tactical plan is obtained by minimizing the deviations of the resources consumption to the target levels of resources utilization. Some capacity is reserved for emergency care. To deal with the deviation between actually arriving patients and the average number of patients on which the tactical plan is based, we consider the option of planning a higher number of patients (overplanning). To adapt the tactical plan to the actual stream of elective patients, we also consider flexibility rules. Overplanning and flexibility leads to a weekly schedule of elective patients. This schedule is modified to account for emergency patients. Scheduled elective patients may be cancelled and emergency patients may be sent to other hospitals. Cancellations rules for both types of patients rely on the possibility to exceed the available capacities. Several performance indicators are defined to assess patient service/dissatisfaction and hospital efficiency. Simulation results show a trade-off between hospital efficiency and patient service. We also obtain a rank of the different strategies: overplanning, flexibility and cancellation rules.