On the design of custom packs: grouping of medical disposable items for surgeries

A custom pack combines medical disposable items into a single sterile package that is used for surgical procedures. Although custom packs are gaining importance in hospitals due to their potential benefits in reducing surgery setup times, little is known on methodologies to configure them, especially if the number of medical items, procedure types and surgeons is large. In this paper, we propose a mathematical programming approach to guide hospitals in developing or reconfiguring their custom packs. In particular, we are interested in minimising points of touch, which we define as a measure for physical contact between staff and medical materials. Starting from an integer non-linear programming model, we develop both an exact linear programming (LP) solution approach and an LP-based heuristic. Next, we also describe a simulated annealing approach to benchmark the mathematical programming methods. A computational experiment, based on real data of a medium-sized Belgian hospital, compares the optimised results with the performance of the hospital's current configuration settings and indicates how to improve future usage. Next to this base case, we introduce scenarios in which we examine to what extent the results are sensitive for waste, i.e. adding more items to the custom pack than is technically required for some of the custom pack's procedures, since this can increase its applicability towards other procedures. We point at some interesting insights that can be taken up by the hospital management to guide the configuration and accompanying negotiation processes.