A mean–variance model to optimize the fixed versus open appointment percentages in open access scheduling systems

Although healthcare quality may improve with short-notice scheduling and subsequently higher patient show-up rates, the variability in patient flow may negatively impact the service design. This study demonstrates how to select the percentage for short-notice or open appointments in an open access scheduling system subject to two quality performance metrics. Specifically, we develop a mean–variance model and an efficient solution procedure to help clinic administrators determine the open appointment percentage subject to increasing the average number of patients seen while also reducing the variability. Our numerical results indicate that for cases with high patient demand and high patient no-show rates for fixed appointments, one or more Pareto optimal percentages of open appointments significantly decrease the variability in the number of patients seen with only a negligible decrease in the expected number of patients seen. While our method provides a useful tool for clinic administrators, it also presents a modeling foundation for open access scheduling with quality management objectives to smooth patient flow and improve capacity utilization.Journal Articl

Single versus hybrid time horizons for open access scheduling

Difficulty in scheduling short-notice appointments due to schedules booked with routine check-ups are prevalent in outpatient clinics, especially in primary care clinics, which lead to more patient no-shows, lower patient satisfaction, and higher healthcare costs. Open access scheduling was introduced to overcome these problems by reserving enough appointment slots for short-notice scheduling. The appointments scheduled in the slots reserved for short-notice are called open appointments. Typically, the current open access scheduling policy has a single time horizon for open appointments. In this paper, we propose a hybrid open access policy adopting two time horizons for open appointments, and we investigate when more than one time horizon for open appointments is justified. Our analytical results show that the optimized hybrid open access policy is never worse than the optimized current single time horizon open access policy in terms of the expectation and the variance of the number of patients consulted. In nearly 75% of the representative scenarios motivated by primary care clinics, the hybrid open access policy slightly improves the performance of open access scheduling. Moreover, for a clinic with strong positive correlation between demands for fixed and open appointments, the proposed hybrid open access policy can considerably reduce the variance of the number of patients consulted.Journal Articl

Matching daily healthcare provider capacity to demand in advanced access scheduling systems

Advanced access scheduling, introduced in the early 1990s, is reported to significantly improve the performance of outpatient clinics. The successful implementation of advanced access scheduling requires the match of daily healthcare provider capacity with patient demand. In this paper, for the first time a closed-form approach is presented to determine the optimal percentage of open-access appointments to match daily provider capacity to demand. This paper introduces the conditions for the optimal percentage of open-access appointments and the procedure to find the optimal percentage. Furthermore, the sensitivity of the optimal percentage of open-access appointments to provider capacity, no-show rates, and demand distribution is investigated. Our results demonstrate that the optimal percentage of open-access appointments mainly depends on the ratio of the average demand for open-access appointments to provider capacity and the ratio of the show-up rates for prescheduled and open-access appointments.Journal Articl

On-line content uniformity determination of tablets using low-resolution Raman spectroscopy

Analytical techniques for rapid and nondestructive content uniformity determination of pharmaceutical solid dosage forms have been studied for several years in an effort to replace the traditional wet chemistry procedures, which are labor intensive and time consuming. Both Raman spectroscopy and near-infrared spectroscopy have been used for this purpose, and predictability errors are approaching those of the traditional techniques. In this study, a low-resolution Raman spectrometer was utilized to demonstrate the feasibility of both rapid at-line and on-line determination of tablet content uniformity. Additionally, sampling statistics were reviewed in an effort to determine how many tablets should be assayed for specific batch sizes. A good correlation was observed between assay values determined by high-performance liquid chromatography and Raman analysis. Due to rapid acquisition times for the Raman data, it was possible to analyze far more samples than with wet chemistry methods, leading to a better statistical description of variation within the batch. For at-line experiments, the sampling volume was increased by rotating the laser beam during the acquisition period. For the on-line experiments, the sampling volume was increased by sampling from a stream of tablets moving underneath the Raman probe on a conveyor system. Finally, an approach is proposed for monitoring content uniformity immediately following the compaction process. In conclusion, Raman spectroscopy has potential as a rapid, nondestructive technique for at- or on-line determination of tablet content uniformity.Journal Articl