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Desenvolvimento de heurísticas para o planeamento de cirurgias electivas num hospital público
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Resumo(s)
O crescente aumento do número de cirurgias em lista de espera, nos hospitais públicos, levou
a um elevado tempo de espera por parte dos utentes e, consequentemente, à incapacidade do
cumprimento dos prazos cirúrgicos, por parte dos hospitais. O presente trabalho pretende contribuir para um melhor planeamento da marcação das cirurgias electivas, a realizar no Centro Hospitalar Lisboa Norte (CHLN), com o objectivo de diminuir o tempo de espera dos inscritos para cirurgia. O Ministério da Saúde definiu metas e objectivos para a produção cirúrgica que, actualmente, não estão a ser respeitados pelo Centro Hospitalar Lisboa Norte, devido à dimensão elevada das listas de espera e à inexistência dum sistema eficiente de marcação de cirurgias electivas. O desenvolvimento da heurística com duas fases (construtiva e de melhoramento) tem como finalidade um dos grandes objectivos do Serviço Nacional de Saúde (SNS): a diminuição das listas de espera. Em ambas as etapas, os utentes são seleccionados por ordem decrescente de prioridade e de antiguidade (critérios de equidade), regra estipulada pelo Sistema Integrado de Gestão de Inscritos para Cirurgia (SIGIC), e afectos a um bloco, uma sala e um dia do horizonte temporal de planeamento. Na fase construtiva da heurística, agenda-se o maior número possível de utentes em Lista de Inscritos para Cirurgia (LIC) e, na fase de melhoramento, rearranjam-se as intervenções cirúrgicas seleccionadas pela construtiva, por forma a permitir a inclusão de mais cirurgias. São, também, realizadas trocas entre cirurgias do plano e cirurgias em LIC, com o objectivo de aumentar o número de cirurgias no plano. A heurística é testada com dados reais do CHLN e é apresentada uma análise dos resultados de tais testes. Para facilitar a realização do agendamento semanal foi criada uma interface que, de forma bastante simples, sugere uma agenda cirúrgica semanal.
The increasing growth in the number of surgeries in public hospitals’ waiting lists results in an increase in the time that patients have to wait for their surgery and, consequently, in an inability for the hospitals to fulfill surgical deadlines. This work’s aim is to contribute for a better planning for elective surgical appointments in Centro Hospitalar Lisboa Norte (CHLN). The goal of such planning is to decrease the waiting time for the people who are registered for a surgery. Some of the goals appointed by the Portuguese Ministry of Health concerning surgeries are not currently being fulfilled by Centro Hospitalar Lisboa Norte, due to the huge waiting lists, as well as the lack of an efficient system to appoint elective surgeries. In this work, we propose a two-phase heuristic (phase one - construction and phase two - improvement), which aims to achieve one of the Portuguese National Health Service – SNS biggest goals: a decrease in waiting lists. In both phases, patients are chosen based on two criteria: a priority order and an antiquity order which allow us to make our choice in a most equitable way. This rule was defined by Sistema Integrado de Gestão de Inscritos para Cirurgia (SIGIC). The chosen patients are then assigned to a room and day in the time horizon we are planning for. In the construction phase, we schedule surgeries for the largest possible number of patients from the surgery waiting list. Then, in the improvement phase, we rearrange the surgeries so we can include even more surgeries in our plan. In this phase, we also allow changing a surgery from the plan for one still in the waiting list, if by doing so we can increase the number of surgeries in the plan. This heuristic is tested using a set of data provided by CHLN and we present an analysis on the results of such tests. Finally, in order to simplify the weekly surgery appointment, we have created an interface that suggests a way to organize surgeries for a week.
The increasing growth in the number of surgeries in public hospitals’ waiting lists results in an increase in the time that patients have to wait for their surgery and, consequently, in an inability for the hospitals to fulfill surgical deadlines. This work’s aim is to contribute for a better planning for elective surgical appointments in Centro Hospitalar Lisboa Norte (CHLN). The goal of such planning is to decrease the waiting time for the people who are registered for a surgery. Some of the goals appointed by the Portuguese Ministry of Health concerning surgeries are not currently being fulfilled by Centro Hospitalar Lisboa Norte, due to the huge waiting lists, as well as the lack of an efficient system to appoint elective surgeries. In this work, we propose a two-phase heuristic (phase one - construction and phase two - improvement), which aims to achieve one of the Portuguese National Health Service – SNS biggest goals: a decrease in waiting lists. In both phases, patients are chosen based on two criteria: a priority order and an antiquity order which allow us to make our choice in a most equitable way. This rule was defined by Sistema Integrado de Gestão de Inscritos para Cirurgia (SIGIC). The chosen patients are then assigned to a room and day in the time horizon we are planning for. In the construction phase, we schedule surgeries for the largest possible number of patients from the surgery waiting list. Then, in the improvement phase, we rearrange the surgeries so we can include even more surgeries in our plan. In this phase, we also allow changing a surgery from the plan for one still in the waiting list, if by doing so we can increase the number of surgeries in the plan. This heuristic is tested using a set of data provided by CHLN and we present an analysis on the results of such tests. Finally, in order to simplify the weekly surgery appointment, we have created an interface that suggests a way to organize surgeries for a week.
Descrição
Tese de mestrado, Estatística e Investigação Operacional, Universidade de Lisboa, Faculdade de Ciências, 2019
Palavras-chave
Investigação operacional nos serviços de saúde Agendamento semanal de cirurgias eletivas Bloco operatório Heurística Pesquisa local Interface Teses de mestrado - 2019