Reducing Appointment Lead-Time in an Outpatient Department of Gynecology and Obstetrics Through Discrete-Event Simulation: A Case Study

Appointment lead-time is a critical variable in outpatient clinic services. In Gynecology and Obstetrics departments, longer appointment lead times are associated with lower patient satisfaction, the use of more complex healthcare services, development of long-term and severe complications and the increase of fetal, infant and maternal mortality rates. This paper aims to define and evaluate improvement alternatives through the use of Discrete-event simulation (DES). First, input data analysis is performed. Second, the simulation model is created; then, performance metrics are calculated and analyzed. Finally, improvement scenarios are designed and assessed. A case study of a mixed-patient type environment (Perinatology and Gynecobstetrics) in an outpatient department has been explored to verify the effectiveness of the proposed approach. Statistical analysis evidence that appointment lead times could be significantly reduced in both Perinatology and Gynecobstetrics appointments based on the proposed approaches in this paper.

[1]  Daiki Min,et al.  A simulation study of appointment scheduling in outpatient clinics: Open access and overbooking , 2013, Simul..

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

[3]  Soemon Takakuwa,et al.  Simulation Analysis of an Outpatient Department of Internal Medicine in a University Hospital , 2006, Proceedings of the 2006 Winter Simulation Conference.

[4]  Jairo R. Montoya-Torres,et al.  Coupling ant colony optimization and discrete-event simulation to solve a stochastic location-routing problem , 2013, 2013 Winter Simulations Conference (WSC).

[5]  Ronald E. Giachetti,et al.  A simulation study of interventions to reduce appointment lead-time and patient no-show rate , 2008, 2008 Winter Simulation Conference.

[6]  J. Caro,et al.  Model transparency and validation: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force--7. , 2012, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[7]  S. Elkhuizen,et al.  Using computer simulation to reduce access time for outpatient departments , 2007, BMJ Quality & Safety.

[8]  Sally I. McClean,et al.  A modeling framework that combines markov models and discrete-event simulation for stroke patient care , 2011, TOMC.

[9]  Jiju Antony,et al.  Reducing Patient Waiting Time in Outpatient Department Using Lean Six Sigma Methodology , 2014, Qual. Reliab. Eng. Int..

[10]  Thomas R Rohleder,et al.  Using simulation modeling to improve patient flow at an outpatient orthopedic clinic , 2011, Health care management science.

[11]  Yongyong Xu,et al.  A web-based appointment system to reduce waiting for outpatients: A retrospective study , 2011, BMC health services research.

[12]  Sheldon Howard Jacobson,et al.  Application of discrete-event simulation in health care clinics: A survey , 1999, J. Oper. Res. Soc..

[13]  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.

[14]  Xiuli Qu,et al.  A two-phase approach to scheduling multi-category outpatient appointments – A case study of a women’s clinic , 2013, Health care management science.

[15]  Sally I. McClean,et al.  A multi-phase DES modelling framework for patient-centred care , 2016, J. Oper. Res. Soc..

[16]  Paul R. Harper,et al.  Reduced outpatient waiting times with improved appointment scheduling: a simulation modelling approach , 2003, OR Spectr..

[17]  Miguel Angel Ortiz Barrios,et al.  A Methodology for the Creation of Integrated Service Networks in Outpatient Internal Medicine , 2015, AmIHEALTH.

[18]  Herbert Moskowitz,et al.  Improving patient flow at an outpatient clinic: study of sources of variability and improvement factors , 2009, Health care management science.

[19]  Heriberto Felizzola Jiménez,et al.  Reduction of Average Lead Time in Outpatient Service of Obstetrics Through Six Sigma Methodology , 2015, AmIHEALTH.

[20]  D. Berlowitz,et al.  The quality of care for adults with epilepsy: an initial glimpse using the QUIET measure , 2011, BMC health services research.