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A constraint reasoning Approach scheduling: A case of hospital surgical rooms scheduling

Maaroufi Feten1 and Korbaa Ouajdi2


Ensi, University Manouba, Tunis ISITCom, University Sousse, Hamam Sousse fetenmaaroufi@yahoo.fr, Ouajdi.Korbaa@Centraliens-Lille.org
2 1

Abstract. This paper studies operating room scheduling Problem the latter is a very important topic for hospitals due to budget restriction. Operating rooms are considered as the most costly hospital facilities. In the present work, an optimization model for scheduling of operating theater is proposed. This model, is formalize in the form of valued constraints satisfaction problem (VCSP). We will solve with the Branch and Bound algorithm (B\&B). At the end, our approach is validated with randomly generated data, and the computational results are compared with those given by Fei, 2006. Keywords: Scheduling, hybrid flow shop, operating theater, VCSP.

Introduction

The most effective and direct way to manage operating room far from our knowledge is operating room schedule. According to several review made by [11], [5] and [3], the operating rooms represents a bottleneck in most hospitals. In addition, it can consume more than 10% of hospitals annual budget. Effective scheduling of operation rooms, aims to reduce costs while maintaining a good quality of care, has become one of the major priorities of health care institutions. The daily operating rooms scheduling is highly constrained problem. It is also hard to find an optimal solution or at least high quality solutions. According to our knowledge, the constraints satisfaction problem (CSP) are widely used with the scheduling problem such as [1], [13] and [10]; in this paper we use the CSPs extensions such as VCSP [9] and [15] to solve hospital surgical block scheduling problem. This problem consists of scheduling the surgical cases to each time block for each day. Its objective is to minimize the total operating cost of the operating theater, including that of both operating rooms (ORs) and recovery room (RR). The paper is organized as the following. In section 2, we describe the problem, and then we start resolving it. In section 4, the digital experimental results are provided. Lastly, the conclusions and perspectives of the study will be proposed.

Maaroufi Feten1 and Korbaa Ouajdi2

State of the art

Operating theater, consisting of operating rooms and recovery room, is known as one of the most important and expensive sector in a hospital. The operating theater management is complex. In fact surgical case must be planned and scheduled not only in order to minimize the costs of operating rooms but also in order to satisfy the needs and requests of the surgeons, anesthetist, nurses and patients. By taking into consideration the risky situation, the operating theater planning and scheduling problem is one of the most important problems studied. A surgical operation comprises two stages [8]: The peroperative stage: it takes place in the operating room it can also be split into three phases: the first one consists of preparing the operating room for the surgery; the second phase is the surgical act itself; and the third phase consists of cleaning the operating room. The surgical act begins with the patient set up and anesthesia, followed by the surgery. Then, the patient is transferred to the post anesthesia RR. The post anesthesia stage starts after the surgical act and takes place in the RR where the patient is controlled until complete recovery. In hospitals, three strategies are commonly applied to use the time slots, are respectively called block scheduling, open scheduling and modified scheduling strategies. Block scheduling: species surgeons or group of surgeon are assigned a set time blocks. Normally for some weeks or months, in which they can arrange their surgical cases. In the pure form, the surgeon or group owns their time blocks. Any time of those can be released. Open scheduling allows surgical cases to be assigned to an operating room available at the convenience of the surgeons. The Modified scheduling: block scheduling is modified in two ways to increase its flexibility. Many times are released at an agreed-upon time before surgery. Few studies in the literature address the issue of reducing costs through a better use of the operating rooms. Guinet et al, 2003[14] takes into account the RR while constructing the OR scheduling. They describe the OR scheduling as a two-stage nowait hybrid flow shop problem, where the objective is to minimize the makespan. Jebali et al 2006[8] present the planning and scheduling problem. Where planning consists of assigning operations to OR. Scheduling consists on sequencing operations which have been assigned to an operating room at the previous step. In view of the sequencing step, two strategies are presented; pure sequencing with some reassignments. Experimentation show good performance of the operations sequencing without reconsidering the assignment step in term of patients selection while minimizing total cost. Ghazouanni et al, 2010[4] describe the operating rooms scheduling as a two-stage, with a constraint of blocking on the first stage hybrid flow shop problem. The schedule obtained with mathematical model proposed has been solved with stimulated annealing. Saadani et al 2010 [6] presented an operating theater scheduling open shop problem where the operations are associated to surgeon nomads, the objective is to minimize the total operating time of the operating theater. Experimentation show good performance of the heuristics NEH (Nawaz, Enscore and Ham) whatever the used assignment heuristics is FAM (First Available Machine), MAT, H1and LBM (Last Busy Machine).

A constraint reasoning Approach scheduling: A case of hospital surgical rooms scheduling 3

In this paper, we will compare our results to [7], and adapted for the need of this study. The approach developed by Fei 2006 was chosen because it is one of the approaches taking into account both the operating and the recovery rooms. The objective is to minimize the total operating cost of the operating theater. The schedule obtained has been solved with a hybrid genetic algorithm. This approach is applied to solve a scheduling problem in the strategy of block scheduling problems.
3 Our approach

3.1

Problem statements

As mentioned above, in this paper we are interested in scheduling ORs problem with the strategy of block scheduling. In the block scheduling strategy, each surgeon or surgical group is proprietor of one or several block time according to his/her availability and his/her needs per day and per week [12]. The block time presents the time blocks allotted to each surgeon. In this section a surgical blocks scheduling model is built to schedule the surgical cases to each time blocks for each day. As mentioned above, the operating theater consists of two parts, a set of operating rooms and recovery room containing several recovery beds. In our model, we have to take into account our objective function as the minimization of the sum of weights makespan, and the patient should be transferred to the RR after being treated in a ORs and stay there till he comes around. However, he will have to remain in the ORs where he is treated if there is no recovery bed available in the RR. In this case, if one patient regains his consciousness before one recovery bed becomes available in the RR, he will be transferred to the ward without staying in the RR. The problem may be identified as a two-stage hybrid flow shop. The first stage is compared to M1 specialized time blocks, which are assigned to the ORs in advance. The second stage consists of M2 recovery beds in the RR. At the planning phase, only the operating time of the surgical case i, renamed as t i 1, at this scheduling phase, is estimated in advance, but at this phase we suppose that the RR time of patient after the operation, t i 2, can also be estimated in advance. The studied problem is NP-complete [7]. As we know, no existing methods can efficiently obtain the optimal solution for the NP-Complete problem; most of the researchers focus on developing heuristic or meta-heuristics methods in order to find an optimal solution, or at least high quality solution, in reasonable time. Encouraged by the good performance of CSPs for NP-Complete problems, in this paper, we propose a three-phase decomposition approach in phase 1, we formalize our problem of VCSP; in phase 2, and we simplify it by arc consistency algorithm W-AC3 [9] to prune the search space to be explored by exploitation of the problem constraints. In phase 3, we solve by Branch & bound algorithm.

Maaroufi Feten1 and Korbaa Ouajdi2

3.2

Optimization model as VCSP

CSP framework makes it possible to present only satisfaction problems whereas, the experiment shows that most real problems are combining satisfaction and optimize problem. In such problem coexist of the hard constraints which must imperatively be satisfied and soft constraints, which represents preferences and are to be satisfied as soon as possible. It is what justified the extension VCSP framework by associating weights [15]. Valued CSP extends the classical CSP framework (X, D, C) by associating weights (costs) to tuples. X= {X 1 X n } is a set of variable; D= {D 1 D n } is a finite domain value; C= {C 1 ... C m } is a set of constraints. In general, costs are specified by means of a so-called valuation structure. A valuation structure is a triple S = (E, , ), where E is the set of costs totally ordered by . The maximum and the minimum costs are noted and , respectively. is a commutative, associative and monotonic operation on E used to combine costs. is the identity element and is absorbing. 3.3 The surgical blocks scheduling as VCSP: optVCSP

Variables: 1 i, j =1 If case i starts before case j in stage 1; 0 otherwise 2 i, j =1 If case I starts before case j in stage 2; 0 otherwise PI i, k =1 If the patient i is scheduled in time blocks k; 0 otherwise PIC i, k =1 If the patient i is scheduled in time blocks k; within planning phase; 0 otherwise Lit i, k =1 If the patient i will occupy a bed k S i : Scheduled start time of case i in stage 1 S i : Scheduled start time of patient i in stage 2 TO k : Opening time for time blocks k TF k : Closing time for time blocks k t1 i : surgical duration of case i t2 i : Recovery duration of case i i : Latency patient in operating room Domains: S i, S i [0, 720] TO k , TF k [0, 720] t1 i [30, 150] t2 i [15, 60] i [0, 15]

A constraint reasoning Approach scheduling: A case of hospital surgical rooms scheduling 5

Constraints:

1, N] (13) Equation 1: a case cannot be scheduled in an operating theater before it is open. Equation 2: an operating theater cannot have more than one case scheduled in it at a time. Equation 3: a case cannot be assigned to an operating theater. Equation 4: a surgeon cannot work on more case at time Equation 5: a bed cannot be occupied more than one patient at time. Equation 6: a patient cannot be assigned more than one bed of the recovery room. Equation 7: determines whether one case is scheduled before another in stage 1. Equation 8: determines whether one case is scheduled before another in stage 2. Equation 9: calculates the scheduled finish time of each operating theater. Equation 10: calculates the finish time of each time blocks. Equation 11-13: integrality constraints. Valuation: In our model, the valuation is associated with Nuees Dynamic method [2], which rests primarily on the use on the concept of associated core with each constraint.

Maaroufi Feten1 and Korbaa Ouajdi2

3.4

Simplification by W-AC3

Since their solving is a NP-complete problem, filtering technique which simplifies the task by eliminating some local inconsistencies is particularly studied. Arcconsistency is the most used filtering technique. The algorithm uses two procedures. Function Prunevar (i), prunes nodeinconsistent values in D i and returns true if the domain is changed. Procedure FindSupportsAC3 (I, j), projects C ij over C i , and for each value a D i it search the value v D j which satisfies the corresponding constraints. Procedure FindSupportsAC3 (i, j) Begin Supp: =0; For each a D i do For each C i, j C do If C i, j (a, v) is not consistent then Supp: = 1; Return supp; End. Function Prunevar (i) Begin Change: = false; For each a D i do D i : = Di-{a}; Change: = true; Return change; End. 3.5 Resolution by Branch and bound

VCSP are usually solved with branch and bound search, which explores a tree where each node represents an assignment. Internal nodes stand for partial assignment and leaves stand for total ones. From an arbitrary node, children are obtained by selecting one unassigned variable and assigning one value for each child. During search the algorithm keeps the cost of the best solution found so far. At each operational program, the algorithm computes a lower bound proposed in [7] of the best solution.

Experimentation

To evaluate OptVCSP, we compare our results with the results of [7]. In this later study, Fei compare the hybrid genetic algorithm with genetic algorithm and taboo search algorithm. Experimentation show that the hybrid genetic algorithm proposed can always find the best value for the objective function, compared to the other algorithms.

A constraint reasoning Approach scheduling: A case of hospital surgical rooms scheduling 7

The hardware used to run optVCSP is a Pentium dual (1,78GHz, memory 1GB, operating system: windows XP) it has been solved by Eclipse SDK 3.6. 4.1 Data

In order to evaluate the proposed model, 10 problems instances of different size have been used. The number of surgical cases is 40, 80, 120, and 160. Surgical act execution time t1 is generated from normal distribution between [30, 150] with the mean 60 minutes and the standard deviation 15 minutes. Recovery time of the patient from surgical case I, t2 is also generated from normal distribution between [15, 60] with the mean equal to its corresponding surgical cases operating time minus 10, and the deviation 15 minutes, similar to the method described by [Fei, 2006] with Pearson III distribution. The cost ratio between one hour of operating room and that of the recovery room, w, is set to be 5.8. 4.2 Results

Costsol: Objective value given by our model; Binf: value of the lower bound proposed in [7]; CPUsol: the computational time of our method.
Table 1. Results given by optVCSP Patient number 40 80 120 160 Costsol Binf CPUsol

4617,78 4907,79 5086,51 5155,42

4614,61 4906,75 5023,43 5144,40

4,57 12,07 20,53 43,59

The table 1 shows the numerical results for scheduling problem. It indicates that OptVCSP can always obtain a solution with best value of objective values. Whats more, the solution obtained by our approach is always very close to the lower bound, this shows that approximate solutions obtained are of good quality and very close to optimal solution. Computation time is improved too. To show the effectiveness of OptVCSP, we have recourse to three ratios: CPURatio = CPUsol / CPU [7];

Maaroufi Feten1 and Korbaa Ouajdi2

costRatio = Costsol / cout [7]; BinfRatio = Binf / NLB [7]. According to these 3 ratios, we can deduce a better performance from OptVCSP if the ratio values are lower than 1.
Table 2. Values of ratios

Patient number

costRatio

BinfRatio

CPURatio

40 80 120 160 Average

0,95 1,03 0,98 0,96 0,98

0,95 1,03 0,97 0,96 0,97

1,05 0,48 0,53 0,63 0,67

OptVCSP shows effectiveness compared to the result of Fei [7]. Indeed, the table 2 indicates that it gives a better result when the number of surgical cases is lower than 40 and higher than 120, thought no big difference is found between those results. For the CPU time, our approach is better and less expensive than the other approaches. This result confirms the effectiveness of the VCSPs.

Conclusion

This paper develops a new approach via VCSP to solve an operating rooms scheduling problem with block scheduling. Our approach is based on the VCSP formalism which is proposed by [15] to solve a NP-Complete problem. The computation results show that OptVCSP is competitive and requires less computation time than the existing approach [7]. We have come to these results thanks to the constraint formalism and the aggregated known methods to solve it. In the future, we can: Study the problem with open or modified scheduling strategies; Resolution can then use many other meta-heuristics; To formalize our mathematic model with Max- CSP or CSOP formalism and to compare with optVCSP model.

A constraint reasoning Approach scheduling: A case of hospital surgical rooms scheduling 9

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