10:30 AM - 11:00 AM
Static and Dynamic Appointment Scheduling to Meet Access Time Norms
Appointment scheduling systems for outpatient clinics have great influence on efficiency and timely access to health care services. In the Netherlands, outpatient clinics have to comply with national access time norms. The number of new patients per week typically fluctuates throughout the year, and capacity at the clinic varies because doctors have other obligations than the outpatient clinic. Most outpatient clinics use tactical appointment schedules in which capacity is reserved for each patient type. Due to the varying supply and demand, overbooking is often unavoidable to provide patients appointments within the access time norms. Overbooking may result in doctors working in overtime, and large waiting times for patients.
We optimize the tactical appointment schedule with respect to access time by invoking a Mixed Integer Program. Additionally, we introduce flexible scheduling methodologies to cope with the varying demand at the clinic, and optimally allocate the flexible capacity by means of Markov Decision Theory. We apply the methodology to a case study of the Surgical outpatient clinic of the Jeroen Bosch Hospital, a large Dutch teaching hospital facing the above mentioned problems. Numerical results from a Discrete Event Simulation provide insights to the improvements and the benefits of flexible scheduling.
11:00 AM - 11:30 AM
Strategies for Interday Appointment Scheduling
When faced with a medical problem, patients often contact their primary care physicians first. In primary care mainly two types of patient requests exist: urgent or same-day appointments and prescheduled appointments which are booked in advance. How many and where to schedule time slots for prescheduled appointments influence direct and indirect waiting times for patients, the number of urgent overflow patients and the utilization of doctors. The number of patient requests differs significantly between different seasons, week days and daytime. The challenge is to match capacity with patient requests and provide as little as possible prescheduled time slots to provide as many same-day appointments as possible during regular working hours while ensuring comfortable appointments. Deciding on the amount of appointment slots has not yet been focused on in literature. We developed a multi-criteria MILP model that determines the number of prescheduled appointments a physician should plan for in a workday. Appointment schedules are regularly influenced by uncertain demands due to amount of acute patients, interarrival times and treatment durations. Consequently, the performance of an appointment system depends on various uncertain parameters. Based on an exemplary case study, we show how appointment slot allocation influences different criteria and how to find good compromise solutions.
11:30 AM - 12:00 PM
Appointment Scheduling at a Radiology Department with Unscheduled arrivals and reprioritization
Radiology departments offer services to other hospital departments, as well as to outside health care providers (e.g., primary care physicians). Radiology resources herein are often highly utilized. One of these resource types is CT scanners, which are the focus of this study. CT scanners receive two types of patients: outpatients that arrive via appointments, and (unscheduled) inpatients from both the emergency department and wards. Of these unscheduled requests, some patients require immediate attention, and should be diagnosed as soon as possible, while others are urgent but may wait for some time. These urgent patients however must be seen within a given time frame. In this paper, we investigate the effect of an offered appointment schedule on the waiting time for scheduled patients, as well as lateness for unscheduled patients of different urgency categories. The radiology department is modelled as a discrete time (slotted) queuing model. Herein a slot corresponds to a single (appointment) slot during which patients are diagnosed. Using computer simulation we heuristically evaluate and search for appointment schedules that minimize patient waiting time. This is done using data of a Dutch hospital’s radiology department. Preliminary results of this approach show that scheduled patients’ waiting times may be reduced compared to currently used schedules, while unscheduled patients may still be diagnosed within the stated time windows.