This paper provides a comprehensive survey of research on appointment scheduling in outpatient services. Effective scheduling systems have the goal of matching demand with capacity so that resources are better utilized and patient waiting times are minimized. Our goal is to present general problem formulation and modeling considerations, and to provide taxonomy of methodologies used in previous literature. Current literature fails to develop generally applicable guidelines to design appointment systems, as most studies have suggested highly situation-specific solutions. We identify future research directions that provide opportunities to expand existing knowledge and close the gap between theory and practice.

Outpatient scheduling in health care: a review of literature

This study examined the relationship between patient waiting time and willingness to return for care and patient satisfaction ratings with primary care physicians. Cross-sectional survey data on a convenience sample of 5,030 patients who rated their physicians on a web-based survey developed to collect detailed information on patient experiences with health care. The survey included self-reported information on wait times, time spent with doctor, and patient satisfaction. Longer waiting times were associated with lower patient satisfaction (p < 0.05), however, time spent with the physician was the strongest predictor of patient satisfaction. The decrement in satisfaction associated with long waiting times is substantially reduced with increased time spent with the physician (5 minutes or more). Importantly, the combination of long waiting time to see the doctor and having a short doctor visit is associated with very low overall patient satisfaction. The time spent with the physician is a stronger predictor of patient satisfaction than is the time spent in the waiting room. These results suggest that shortening patient waiting times at the expense of time spent with the patient to improve patient satisfaction scores would be counter-productive.

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Willing to wait?: The influence of patient wait time on satisfaction with primary care

We report on the use of discrete event simulation modeling to support process improvements at an orthopedic outpatient clinic. The clinic was effective in treating patients, but waiting time and congestion in the clinic created patient dissatisfaction and staff morale issues. The modeling helped to identify improvement alternatives including optimized staffing levels, better patient scheduling, and an emphasis on staff arriving promptly. Quantitative results from the modeling provided motivation to implement the improvements. Statistical analysis of data taken before and after the implementation indicate that waiting time measures were significantly improved and overall patient time in the clinic was reduced.

Using simulation modeling to improve patient flow at an outpatient orthopedic clinic.

This paper investigates two approaches to patient classification: using patient classification only for sequencing patient appointments at the time of booking and using patient classification for both sequencing and appointment interval adjustment. In the latter approach, appointment intervals are adjusted to match the consultation time characteristics of different patient classes. Our simulation results indicate that new appointment systems that utilize interval adjustment for patient class are successful in improving doctors' idle time, doctors' overtime and patients' waiting times without any trade-offs. Best performing appointment systems are identified for different clinic environments characterized by walk-ins, no-shows, the percentage of new patients, and the ratio of the mean consultation time of new patients to the mean consultation time of return patients. As a result, practical guidelines are developed for managers who are responsible for designing appointment systems.

Assessment of patient classification in appointment system design

In this survey we review quantitative health care models to illustrate the extent to which they encompass multiple hospital departments. The paper provides general overviews of the relationships that exists between major hospital departments and describes how these relationships are accounted for by researchers. We find the atomistic view of hospitals often taken by researchers is partially due to the ambiguity of patient care trajectories. To this end clinical pathways literature is reviewed to illustrate its potential for clarifying patient flows and for providing a holistic hospital perspective.

/pdf/a-survey-of-health-care-models-that-encompass-multiple-42tk6v2rpl.pdf

A Survey of Health Care Models that Encompass Multiple Departments

Patient waiting time in outpatient clinics is often the major reason for patients' complaints about their experiences of visiting outpatient clinics. Therefore, patient satisfaction with waiting time plays a crucial role in the process of health quality assurance or quality management. This paper reports the results of a survey on patient attitude towards waiting in an outpatient surgery clinic. Generally patients appear reasonably satisfied if they wait no more than 37 minutes when arriving on time, and no more than 63 minutes when late for appointments. Patients coming up to 15 minutes early are prepared to take full responsibility for the extra waiting caused, but the patients coming even earlier intend to be seen earlier and are only prepared to wait 15 minutes longer than otherwise. The potential applications of patient attitude towards waiting in the quality assurance process, ie setting up waiting time limits and designing patient dispatching rules, are also discussed.

Patient attitude towards waiting in an outpatient clinic and its applications.

BACKGROUND Serum protein induced by vitamin K absence or antagonist-II (PIVKA-II) is a promising biomarker for hepatocellular carcinoma (HCC) surveillance. AIM To identify the contributing factors related to the abnormal elevation of PIVKA-II level and assess their potential influence on the performance of PIVKA-II in detecting HCC. METHODS This study retrospectively enrolled in 784 chronic liver disease (CLD) patients and 267 HCC patients in Mengchao Hepatobiliary Hospital of Fujian Medical University from April 2016 to December 2019. Logistic regression and the area under the receiver operating characteristic curve (AUC) were used to evaluate the influencing factors and diagnostic performance of PIVKA-II for HCC, respectively. RESULTS Elevated PIVKA-II levels were independently positively associated with alcohol-related liver disease, serum alkaline phosphatase (ALP), and total bilirubin (TBIL) for CLD patients and aspartate aminotransferase (AST) and tumor size for HCC patients (all P < 0.05). Serum PIVKA-II were significantly lower in patients with viral etiology, ALP ≤ 1 × upper limit of normal (ULN), TBIL ≤ 1 × ULN, and AST ≤ 1 × ULN than in those with nonviral disease and abnormal ALP, TBIL, or AST (all P < 0.05), but the differences disappeared in patients with early-stage HCC. For patients with TBIL ≤ 1 × ULN, the AUC of PIVKA-II was significantly higher compared to that in patients with TBIL > 1 × ULN (0.817 vs 0.669, P = 0.015), while the difference between ALP ≤ 1 × ULN and ALP > 1 × ULN was not statistically significant (0.783 vs 0.729, P = 0.398). These trends were then more prominently perceived in subgroups of patients with viral etiology and HBV alone. CONCLUSION Serum PIVKA-II has better performance in detecting HCC at an early stage for CLD patients with normal serum TBIL.

Xiao-Ming Huang

Papers

Patient attitude towards waiting in an outpatient clinic and its applications.

Better performance of PIVKA-II for detecting hepatocellular carcinoma in patients with chronic liver disease with normal total bilirubin