زمانبندي پيشگيرانه واكنشي روزانه اتاق هاي عمل با در نظرگرفتن برنامه روزانه پرستاران

The demand for healthcare services is increasing worldwide, presenting researchers with the challenge of maximizing patient care while keeping incurred costs affordable. There has been a particular focus on the operating room sector as a central bottleneck in the hospital process. Elective patients must be allocated to operating rooms according to planned schedules and then sequenced for treatment. However, several factors complicate this scheduling process, including the varying preferences of stakeholders (hospital managers, patients, surgeons, etc.), and various human and physical resource constraints. To address the issue of operating room scheduling, the availability of resources such as qualified operating rooms, scarce and expensive equipment, and the necessary human resources for each surgical procedure must be considered in accordance with hospital conditions. Another important factor to take into account is the accurate and timely estimation of frequent disruptions caused by the arrival of emergency patients, which is a key aspect that distinguishes the operating room from other processes. Sharing operating room capacity between elective and emergency surgeries seems to be a natural way to improve operating room utilization. However, sharing operating room capacity poses significant challenges due to the random arrival of emergencies and the nature of emergency surgeries. In this thesis, the daily scheduling problem of operating rooms is examined, considering a blocking strategy along with the daily scheduling of operating room nurses for both elective and emergency patients. A proactive-reactive mathematical model has been designed to create a scheduling program for elective and emergency patients. This model proactively generates a scheduling plan considering the probability of emergency patient arrivals and the relevant resources, and if an emergency patient arrives, a rescheduling is performed for the remaining elective patients after the emergency arrival. The goal of proactive scheduling is to minimize penalties from not scheduling elective patients, the amount of overtime costs for operating rooms, and the costs of employing on-call nurses. The goal of reactive scheduling is to minimize changes resulting from the initial schedule and the current schedule, as well as penalties from violating the waiting time limits for emergency patients, in addition to the objectives of proactive scheduling. To solve the model, randomly generated data has been produced and eva‎luated. Finally, an analysis of the influencing factors has been conducted. In addition to the duration of surgery, which is one of the most important components in the proposed proactive-reactive scheduling, the allowed waiting time limits and the amount of waiting time exceeding the waiting time limits for emergency patients significantly impact other factors considered in the reactive model.

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