A cost-effective urgent care policy to improve patient access in a dynamic scheduled clinic setting

Patient no-show in outpatient clinics has been a long recognized issue, which negatively impacts clinic operational efficiency in terms of costs and patient access to care. One way to reduce these negative impacts is to allow urgent walk-ins during a clinic day. Some clinics allow random walk-ins and some purposely leave open time slots to accommodate them. The objective of this paper is to develop a cost-effective urgent care policy that is added on top of a full schedule and takes into account scheduled patients’ no-show rates to improve patient access to care in a dynamic clinic environment. The findings indicate that the proposed approach outperforms the current random and urgent slot approaches. This paper demonstrates a dynamic approach for accommodating urgent patients into a patient scheduling system, based on the prediction of an individual patient's no-show probability and the maximum number of urgent patients allowed.

[1]  J. Warden 4.5 Million outpatients miss appointments , 1995 .

[2]  C. Rust,et al.  Patient appointment failures in pediatric resident continuity clinics. , 1995, Archives of pediatrics & adolescent medicine.

[3]  Kum Khiong Yang,et al.  A new appointment rule for a single-server, multiple-customer service system , 1998 .

[4]  Karolina J. Glowacka,et al.  A hybrid data mining/simulation approach for modelling outpatient no-shows in clinic scheduling , 2009, J. Oper. Res. Soc..

[5]  R A Deyo,et al.  Dropouts and broken appointments. A literature review and agenda for future research. , 1980, Medical care.

[6]  Y. Huang,et al.  Dynamic overbooking scheduling system to improve patient access , 2012, J. Oper. Res. Soc..

[7]  Ronald E. Giachetti,et al.  A Stochastic Mathematical Appointment Overbooking Model for Healthcare Providers to Improve Profits , 2006, IEEE Transactions on Systems, Man, and Cybernetics - Part A: Systems and Humans.

[8]  Diwakar Gupta,et al.  Appointment scheduling in health care: Challenges and opportunities , 2008 .

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

[10]  Luc Cassivi,et al.  Evaluating clinical trial management systems: A simulation approach , 2012, Ind. Manag. Data Syst..

[11]  Dervin Jv,et al.  The no-show patient in the model family practice unit. , 1978 .

[12]  Gina R Kruse,et al.  Factors associated with attendance at a first appointment after discharge from a psychiatric hospital. , 2002, Psychiatric services.

[13]  A. Konnopka,et al.  The health burden and costs of incident fractures attributable to osteoporosis from 2010 to 2050 in Germany—a demographic simulation model , 2013, Osteoporosis International.

[14]  J. Talaga,et al.  Appointment breaking: causes and solutions. , 1992, Journal of health care marketing.

[15]  M. Murray,et al.  Redefining open access to primary care. , 1999, Managed care quarterly.

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

[17]  Kumar Muthuraman,et al.  A stochastic overbooking model for outpatient clinical scheduling with no-shows , 2008 .

[18]  William Shonick,et al.  An Approach to Reducing the Adverse Effects of Broken Appointments in Primary Care Systems , 1977, Medical care.

[19]  J. Vissers,et al.  Selecting a Suitable Appointment System in an Outpatient Setting , 1979, Medical care.

[20]  W. Barron,et al.  Failed appointments. Who misses them, why they are missed, and what can be done. , 1980, Primary care.

[21]  G. Oppenheim,et al.  Failed appointments: a review. , 1979, The Journal of family practice.

[22]  E F Cook,et al.  A multivariate approach to the prediction of no-show behavior in a primary care center. , 1982, Archives of internal medicine.

[23]  R. Chez,et al.  The no-show rate in a high-risk obstetric clinic. , 2000, Journal of women's health & gender-based medicine.

[24]  Gary D. Herrin,et al.  An alternative outpatient scheduling system: Improving the outpatient experience , 2009 .

[25]  T. Rohleder,et al.  Outpatient appointment scheduling with urgent clients in a dynamic, multi‐period environment , 2004 .

[26]  Luis G. Vargas,et al.  Fitting the Lognormal Distribution to Surgical Procedure Times , 2000, Decis. Sci..

[27]  J. Mold,et al.  Reduction and Management of No-Shows by Family Medicine Residency Practice Exemplars , 2007, The Annals of Family Medicine.

[28]  Rodney Wm,et al.  Determinants of no-show appointment behavior: the utility of multivariate analysis. , 1986 .

[29]  R. Fetter,et al.  Patients' waiting time and doctors' idle time in the outpatient setting. , 1966, Health services research.

[30]  J V Dervin,et al.  The no-show patient in the model family practice unit. , 1978, The Journal of family practice.

[31]  Emre A. Veral,et al.  Designing appointment scheduling systems for ambulatory care services , 2006, Health care management science.

[32]  Ateev Mehrotra,et al.  Implementing Open-Access Scheduling of Visits in Primary Care Practices: A Cautionary Tale , 2008, Annals of Internal Medicine.

[33]  English Ec,et al.  Failed appointments: a review. , 1979 .

[34]  J. Talaga,et al.  Predicting appointment breaking. , 1995, Journal of health care marketing.

[35]  Barron Wm Failed appointments. Who misses them, why they are missed, and what can be done. , 1980 .

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

[37]  Paul Intrevado,et al.  Effects of clinical characteristics on successful open access scheduling , 2007, Health care management science.

[38]  J. Wijngaard,et al.  The outpatient appointment system: Design of a simulation study , 1979 .

[39]  Steven R. Brown,et al.  Decreased continuity in a residency clinic: a consequence of open access scheduling. , 2009, Family medicine.

[40]  Nan Liu,et al.  Dynamic Scheduling of Outpatient Appointments Under Patient No-Shows and Cancellations , 2010, Manuf. Serv. Oper. Manag..

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

[42]  Stephen R. Lawrence,et al.  Clinic Overbooking to Improve Patient Access and Increase Provider Productivity , 2007, Decis. Sci..