Ancillary service impact on outpatient scheduling.

PURPOSE The paper aims to provide a simulation optimization solution to improve patient scheduling that accounts for varying ancillary service time such as x-ray to minimize patient wait time. DESIGN/METHODOLOGY/APPROACH The two-step approach is to: identify patients' needs for ancillary services while scheduling appointments; and propose an algorithm to determine ancillary service time via simulation optimization. The main aim is to provide sufficient time between arrival at the clinic and the actual examination time for a patient to complete pre-visit activities without contributing significantly to patient wait time. Two case studies are included to demonstrate the approach. FINDINGS Triaging at the appointment-scheduling time saves an average 17 minutes for physician's first consultation in a clinic day, and a 7 percent reduction on current average patient wait time for case 1. Case 2 results in a 9 percent reduction on average patient wait time. The scheduled ancillary service time depends on the frequency and the ancillary service time, and appointment slot design. RESEARCH LIMITATIONS/IMPLICATIONS One limitation is the impact of modeling error on the account of ancillary service times and the modeling assumptions. PRACTICAL IMPLICATIONS The proposed approach provides a studying method for clinic staff to account for ancillary services prior to physicians' visits for a better patient care. Two case studies demonstrated the practicability and promising results on reducing patient waiting. ORIGINALITY/VALUE This article presents a unique approach to considering the required ancillary services in outpatient scheduling system that minimizes patient wait times. The approach will strengthen the existing scheduling methods to allow the time for ancillary services.

[1]  Peter Williams,et al.  Optimization of scheduling patient appointments in clinics using a novel modelling technique of patient arrival , 2012, Comput. Methods Programs Biomed..

[2]  J. Harrington,et al.  Pre-appointment management of new patient referrals in rheumatology: a key strategy for improving health care delivery. , 2001, Arthritis and rheumatism.

[3]  Dennis C. Dietz,et al.  Minimizing expected waiting in a medical appointment system , 2000 .

[4]  Jie Lian,et al.  Clinical Appointment Process: Improvement Through Schedule Defragmentation , 2010, IEEE Engineering in Medicine and Biology Magazine.

[5]  Hon-Shiang Lau,et al.  Minimizing total cost in scheduling outpatient appointments , 1992 .

[6]  Ger Koole,et al.  Optimal outpatient appointment scheduling , 2007, Health care management science.

[7]  T. Cox,et al.  Optimising the queuing system for an ear, nose and throat outpatient clinic , 1985 .

[8]  Kumar Muthuraman,et al.  Sequential clinical scheduling with patient no-shows and general service time distributions , 2010 .

[9]  Emre A. Veral,et al.  OUTPATIENT SCHEDULING IN HEALTH CARE: A REVIEW OF LITERATURE , 2003 .

[10]  Martin L. Puterman,et al.  Reducing patient wait times and improving resource utilization at British Columbia Cancer Agency’s ambulatory care unit through simulation , 2009, Health care management science.

[11]  Ji Lin,et al.  Clinic scheduling models with overbooking for patients with heterogeneous no-show probabilities , 2010, Ann. Oper. Res..

[12]  Franklin Dexter,et al.  Coordination of Appointments for Anesthesia Care Outside of Operating Rooms Using an Enterprise-Wide Scheduling System , 2007, Anesthesia and analgesia.

[13]  Adam P Carpenter,et al.  Managing magnetic resonance imaging machines: support tools for scheduling and planning , 2011, Health care management science.

[14]  Seyfettin Noyan Ogulata,et al.  A Simulation Approach for Scheduling Patients in the Department of Radiation Oncology , 2009, Journal of Medical Systems.

[15]  Edward J. Rising,et al.  A Systems Analysis of a University-Health-Service Outpatient Clinic , 1973, Oper. Res..

[16]  A. K. A. Wijewickrama.  Simulation analysis for reducing queues in mixed-patients' outpatient department , 2006 .

[17]  Juha Mykkänen,et al.  Task Analysis and Application Services for Cross-Organizational Scheduling and Citizen eBooking , 2009, MIE.

[18]  Thomas R. Rohleder,et al.  Scheduling outpatient appointments in a dynamic environment , 1996 .

[19]  P S Gibbons,et al.  Coordinated delivery of clinical care: the "re-integration" of the medical group practice. , 1992, Proceedings. Symposium on Computer Applications in Medical Care.