Bottleneck Analysis to Reduce Surgical Flow Disruptions: Theory and Application

The work flow of surgical operations in emergency department and operating rooms can be interrupted due to various disruptions. Reducing such disruptions is of significant importance to ensure successful operations. In this paper, we introduce a continuous-time Markov chain model to analyze the disruptions and their impacts. Analytical formulas have been derived to evaluate the probabilities of normal operations and disruptions. A continuous improvement method has been developed to identify the disruption that impedes surgical operation in the strongest manner. Such a disruption is referred to as the bottleneck disruption. Specifically, the bottleneck disruption can be further categorized with respect to interruption time (BN- t) and frequency (BN- f), so that reducing the interruption time and frequency of the bottleneck, respectively, can lead to the largest improvement in normal operation. An application of the method at an emergency department of a large academic medical center is presented to illustrate the effectiveness of the model and the improvement approach.