39 research outputs found

    Designing cyclic appointment schedules for outpatient clinics with scheduled and unscheduled patient arrivals

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    We present a methodology to design appointment systems for outpatient clinics and diagnostic facilities that offer both walk-in and scheduled service. The developed blueprint for the appointment schedule prescribes the number of appointments to plan per day and the moment on the day to schedule the appointments. The method consists of two models that are linked by an algorithm; one for the day process that governs scheduled and unscheduled arrivals on the day and one for the access process of scheduled arrivals. Appointment schedules that balance the waiting time at the facility for unscheduled patients and the access time for scheduled patients, are calculated iteratively using the outcomes of the two models. The method is of general nature and can therefore also be applied to scheduling problems in other sectors than health care

    Appointment scheduling with unscheduled arrivals and reprioritization

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    Inspired by the real life problem of a radiology department in a Dutch hospital, we study the problem of scheduling appointments, taking into account unscheduled arrivals and reprioritization. The radiology department offers CT diagnostics to both scheduled and unscheduled patients. Of these unscheduled patients, some must be seen immediately, while others may wait for some time. Herein a trade-off is sought between acceptable waiting times for appointment patients and unscheduled patients’ lateness. In this paper we use a discrete event simulation model to determine the performance of a given appointment schedule in terms of waiting time and lateness. Also we propose a constructive and local search heuristic that embeds this model and optimizes the schedule. For smaller instances, we verify the simulation model as well as compare our search heuristics’ performance with optimal schedules obtained using a Markov reward process. In addition we present computational results from the case study in the Dutch hospital. These results show that a considerable decrease of waiting time is possible for scheduled patients, while still treating unscheduled patients on time

    Taxonomic classification of planning decisions in health care: a review of the state of the art in OR/MS

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    We provide a structured overview of the typical decisions to be made in resource capacity planning and control in health care, and a review of relevant OR/MS articles for each planning decision. The contribution of this paper is twofold. First, to position the planning decisions, a taxonomy is presented. This taxonomy provides health care managers and OR/MS researchers with a method to identify, break down and classify planning and control decisions. Second, following the taxonomy, for six health care services, we provide an exhaustive specification of planning and control decisions in resource capacity planning and control. For each planning and control decision, we structurally review the key OR/MS articles and the OR/MS methods and techniques that are applied in the literature to support decision making

    A Simulation-Based Evaluation Of Efficiency Strategies For A Primary Care Clinic With Unscheduled Visits

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    In the health care industry, there are strategies to remove inefficiencies from the health delivery process called efficiency strategies. This dissertation proposed a simulation model to evaluate the impact of the efficiency strategies on a primary care clinic with unscheduled walk-in patient visits. The simulation model captures the complex characteristics of the Orlando Veteran\u27s Affairs Medical Center (VAMC) primary care clinic. This clinic system includes different types of patients, patient paths, and multiple resources that serve them. Added to the problem complexity is the presence of patient no-shows characteristics and unscheduled patient arrivals, a problem which has been until recently, largely neglected. The main objectives of this research were to develop a model that captures the complexities of the Orlando VAMC, evaluate alternative scenarios to work in unscheduled patient visits, and examine the impact of patient flow, appointment scheduling, and capacity management decisions on the performance of the primary care clinic system. The main results show that only a joint policy of appointment scheduling rules and patient flow decisions has a significant impact on the wait time of scheduled patients. It is recommended that in the future the clinic addresses the problem of serving additional walk-in patients from an integrated scheduling and patient flow viewpoint

    Organizing Multidisciplinary Care for Children with Neuromuscular Diseases

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    The Academic Medical Center (AMC) in Amsterdam, The Netherlands, recently opened the `Children's Muscle Center Amsterdam' (CMCA). The CMCA diagnoses and treats children with neuromuscular diseases. These patients require care from a variety of clinicians. Through the establishment of the CMCA, children and their parents will generally visit the hospital only once a year, while previously they visited on average six times a year. This is a major improvement, because the hospital visits are both physically and psychologically demanding for the patients. This article describes how quantitative modelling supports the design and operations of the CMCA. First, an integer linear program is presented that selects which patients to invite for a treatment day and schedules the required combination of consultations, examinations and treatments on one day. Second, the integer linear program is used as input to a simulation to study to estimate the capacity of the CMCA, expressed in the distribution of the number patients that can be seen on one diagnosis day. Finally, a queueing model is formulated to predict the access time distributions based upon the simulation outcomes under various demand scenarios

    Lean Transformation Frameworks for Hospital Departments

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    Critical issues in hospitals include prolonged wait times and soaring expenditures. While Lean methods appear to be a solution to these issues, Lean implementations are difficult to replicate in different healthcare settings because of a lack of well-established methodologies. Therefore, this thesis applies a unified Lean approach to create transformation frameworks for three major types of hospital departments that are facing different challenges attributed to their underlying characteristics. The first part of this thesis discusses a framework for schedule-based and treatment-oriented outpatient departments. The framework identifies the best patient mix, schedule, and staffing levels to reduce wait times and improve the utilisation of critical resources. After implementing the framework, an oncology department can run under a one-day regime while reducing patient visit time by 36.3% and increasing the number of daily chemotherapy treatments by 38.6%. The second part of this thesis describes a framework for shared processes in outpatient departments in which scheduled and unscheduled patients coexist. The framework analyses system capability and devises efficient patient and staff schedules to meet demand with supply in a timely fashion. Implementing the framework in a radiology department results in a 21.4% increase in the number of elective patients and 77.1% and 37.2% decreases in the lead times of emergency patients and elective patients, respectively. The final part of this thesis demonstrates a framework for emergency departments receiving unscheduled patient visits. The framework manages the discharge process and plans staffing and materials to alleviate crowding. The estimated results in a case emergency department are a 50.8% reduction in patient length of stay and 41.5% decrease in occupancy rate of stretchers. The major theoretical contribution of this thesis is its adaptation of several tools, which are organised into a series of structured activities towards Lean systems for different types of hospital departments. In practice, each framework is a comprehensive and step-by-step guideline for hospital managers to follow in their application of Lean to serve more patients, decrease wait time, and use their resources more efficiently. Furthermore, the frameworks are expected to foster a culture of continuous process improvement and facilitate a hospital-wide Lean transformation
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