Optimizing surgical resource allocation for meeting targeted elective surgery waiting times: a simulation-optimization approach

Abstract

Long waiting times for elective surgeries in public hospitals are a major concern. Patient prioritization and setting maximum waiting time targets are key strategies to address this issue. These measures require defining and weighting prioritization criteria, as well as ensuring that sufficient surgical resources are available. The research described in this article was intended to develop a prioritization system for elective patients and determine the optimal allocation of surgical resources to perform surgeries within the maximum waiting times. A systematic literature review was conducted to identify prioritization criteria, which were validated through a focus group discussion. The Analytic Hierarchy Process was then applied to weight the validated criteria. A priority score measuring the patient’s health status was calculated, and that score was then used to categorize the patient into one of four priority groups. Subsequently, a discrete-event simulation model was used to evaluate the effectiveness of the prioritization system, showing reduced waiting times for high-priority patients but longer delays for low-priority patients. To enhance access to surgeries for all patients, a simulation-optimization (SO) model was developed to optimally allocate surgical resources while adhering to maximum waiting times. Simulation results of the SO model’s solution demonstrated significant reductions in waiting times for all patients through increased surgical resources at identified bottlenecks.