The Operating Rooms' Operation Management Under Emergencies

Due to the frequent occurrence of various mass causality incident(MCI),the emergency management in healthcare system has attracted more attention.This thesis is focused on the emergency management in the operating rooms(OR)under MCI.Since MCI has several characteristics,like sudden,urgent,hazard etc,it will cause serious casualties in the short term and bring a large number of emergency surgeries for the OR.Moreover,those patients are almost concentrated in the same specialty,which will bring high pressure to the key resources in OR.It will also lead to a large number of delay in the elective surgeries as well.All of these put forward higher demand for OR emergency management.It is urgent for OR emergency management to quickly allocate and utilize the key resources within limited time after MCI happens and to arrange the emergent patients for surgery service.It calls for a comprehensive exploration on emergency management for OR decision making system.Referring to a decision making tool-GRAI grid used in modeling manufacturing system decision making,an emergency decision making model for current OR emergency management is established according to a survey in the target hospital.And several shortcomings in current OR emergency management are identified,for example,the current emergency decisions are independent of hospital OR scheduling system,and most of them are temporary resource allocation decisions.Hence,those decisions are lack in overall long term planning.The emergency management is combined with surgery planning and scheduling.A cross-time domain(" predicting-planning-preparing-responding")and cross-department analysis is done for OR emergency management.For this reason,this paper propose a whole-life-cycle decision making for OR emergency management.A new GRAI-grid-based decision making system model is reconstructed,and typical scientific problems in different stages are identified.A detail research is done for the optimization problem in preparation stage,i.e.the optimization of surgery planning and resource scheduling.The features for MCI,some specific objectives under MCI,several typical constraints are all identified,and a mathematical model for OR emergency management is established.Several computational cases are designed to fit for different scales and different types cases are generated for validation.After computation analysis,the computational results show that the proposed algorithm can solve the problem with minimal waiting time of elective surgeries while ensure the emergency priority.It can also ensure the increasing the utilization of key resources,while balancing the utilization of other resources as well considering the emergency scheme in reality.This paper attempts to make up for the shortcomings of current emergency management strategy in independent decision making,and proposes a new integrating decision making system to realize the global optimization in emergency management in OR.Finally,the more detailed and quantitative suggestions for typical OR planning and scheduling under emergency incidents is recommended to the hospital in dealing with MCI,which will lead to great significance in the practice on optimization of OR management.