Data_Sheet_1_A Monte Carlo Simulation Approach to Optimizing Capacity in a High-Volume Congenital Heart Pediatric Surgical Center.docx

ImportanceElective surgeries are primarily scheduled according to surgeon availability with less consideration of patients' postoperative cardiac intensive care unit (CICU) length of stay. Furthermore, the CICU census can exhibit a high rate of variation in which the CICU is operating at over-capacity, resulting in admission delays and cancellations; or under-capacity, resulting in underutilized labor and overhead expenditures.
ObjectiveTo identify strategies to reduce variation in CICU occupancy levels and avoid late patient surgery cancellation.
DesignMonte Carlo simulation study of the daily and weekly CICU census at Boston Children's Hospital Heart Center. Data on all surgical admissions to and discharges from the CICU at Boston Children's Hospital between September 1, 2009 and November 2019 were included to obtain the distribution of length of stay for the simulation study. The available data allows us to model realistic length of stay samples that include short and extended lengths of stay.
Main OutcomesAnnual number of patient surgical cancellations and change in average daily census.
ResultsWe demonstrate that the models of strategic scheduling would result in up to 57% reduction in patient surgical cancellations, increase the historically low Monday census and decrease the historically higher late-mid-week (Wednesday and Thursday) censuses in our center.
Conclusions and RelevanceUse of strategic scheduling may improve surgical capacity and reduce the number of annual cancellations. The reduction of peaks and valleys in the weekly census corresponds to a reduction of underutilization and overutilization of the system.

研究背景与重要性：择期手术的排期主要依据外科医生的可出诊时间，对患者术后心脏重症监护病房（Cardiac Intensive Care Unit, CICU）停留时长的考量相对不足。此外，心脏重症监护病房的床位占用情况波动幅度较大：要么处于超负荷运转状态，导致患者收治延迟乃至手术取消；要么处于空置状态，造成人力与运营成本的浪费。
研究目标：旨在明确可降低心脏重症监护病房床位占用波动、避免手术临时取消的优化策略。
研究设计：本研究为蒙特卡洛模拟（Monte Carlo simulation）研究，针对波士顿儿童医院心脏中心的每日及每周心脏重症监护病房床位流量展开分析。研究纳入2009年9月1日至2019年11月期间，波士顿儿童医院心脏重症监护病房所有外科收治患者的入院与出院数据，以获取停留时长分布用于模拟研究。现有数据可支持我们构建涵盖短期及长期停留场景的真实停留时长样本模型。
主要结局指标：年度手术取消患者总数及日均床位占用的变化情况。
研究结果：本研究证实，采用战略性排期模式可使手术取消率最高降低57%；同时可提升本中心周一床位占用的历史低位水平，并降低周中后期（周三与周四）的历史高位床位占用情况。
结论与意义：战略性排期的应用可优化外科手术收治能力，减少年度手术取消案例。平抑每周床位占用的峰值与谷值，可相应降低系统的人力闲置与超负荷运转问题，减少资源浪费。