Approximate dynamic programming approaches for appointment scheduling with patient preferences

et al. 2021

Preprint

Background: Workflow interruptions are frequent in hospital outpatient clinics. Eventually, not only reducing the work efficiency and quality, but also further threatening patient safety. Over the last 10–15 years, research on workflow interruptions in inpatient care has increased, but there is a lack of research on the interruptions in outpatient clinics. The present study aimed to study the differences in physicians' workflow interruptions among outpatient departments in the tertiary hospital in China.Methods: In a tertiary hospital, a standardized observational study of 32 doctors' workflow in outpatient department of four typical clinical specialties was conducted. The record of workflow interruptions was based on a self-made observation instrument after verifying its reliability and validity. Linear regression methods were used to assess outpatient characteristics as predictors of the number of interruptions. The Kruskal-Wallis test was used to analyze the difference about the duration of interruptions among specialties, and the Chi-Square Test was used to examine the sources of interruptions among different specialties, to determine whether interruption source is associated with specialty.Results: The number of patients was the significant independent predictor of the number of interruptions(p<0.001). In terms of work tasks being interrupted, the highest interruption rate occurred when physicians were asking health history: 19.95 interruptions per hour. The distribution of interruption sources among the four clinical specialties were statistically different (Χ2 =16.988, p = 0.049). Conclusion: The findings indicate that physicians' workflow interruptions are connected with many contents in the work system. Further emphasis should be placed on the effective application of hospital management measures in an interrupted environment to promote a safe and efficiency outpatient care.

Section: Previous Studies Have Compared Work Ow Interruptions Among Different Medical Workplaces[8]mentioning

confidence: 99%

An Observational Study of Physicians' Workflow Interruptions in Outpatient Departments in China

Zhu

et al. 2021

Preprint

“…However, it is noticeable that patient choice behaviors, i.e., appointment preference and appointment break, has to be considered when making a schedule decision in this telemedicine service based CHS. As reported in the existing literature [ 11 – 13 ], the telemedicine patients in CHS always break an appointment in a much larger probability than those in the traditional medical service systems.…”

Section: Introductionmentioning

confidence: 99%

Optimal scheduling in cloud healthcare system using Q-learning algorithm

et al. 2022

Complex Intell. Syst.

Cloud healthcare system (CHS) can provide the telemedicine services, which is helpful to cope with the difficulty of patients getting medical service in the traditional medical systems. However, resource scheduling in CHS has to face with a great of challenges since managing the trade-off of efficiency and quality becomes complicated due to the uncertainty of patient choice behavior. Motivated by this, a resource scheduling problem with multi-stations queueing network in CHS is studied in this paper. A Markov decision model with uncertainty is developed to optimize the match process of patients and scarce resources with the objective of minimizing the total medical costs that consist of three conflicting sub-costs, i.e., medical costs, waiting time costs and the penalty costs caused by unmuting choice behavior of patients. For solving the proposed model, a three-stage dynamic scheduling method is designed, in which an improved Q-learning algorithm is employed to achieve the optimal schedule. Numerical experimental results show that this Q-learning-based scheduling algorithm outperforms two traditional scheduling algorithms significantly, as well as the balance of the three conflicting sub-costs is kept and the service efficiency is improved.

“…Compared with patients referred by family doctors, the process of such patients will increase the doctor's workload. Presently, the workflow of outpatient department includes problems such as the incompletely developed appointment registration system ( 14 , 15 ), poor consultation process, and inadequate information applications ( 16 ), which has led to a high frequency of interruptions in outpatient department.…”

Section: Introductionmentioning

confidence: 99%

An Observational Study of Physicians' Workflow Interruptions in Outpatient Departments in China

Zhu

et al. 2022

Front. Public Health

BackgroundWorkflow interruptions are frequent in hospital outpatient clinics. Eventually, not only reducing the work efficiency and quality, but also further threatening patient safety. Over the last 10–15 years, research on workflow interruptions in inpatient care has increased, but there is a lack of research on the interruptions in outpatient clinics. The present study aimed to study the differences in physicians' workflow interruptions among outpatient departments in the tertiary hospital in China.MethodsIn a tertiary hospital, a standardized observational study of 32 doctors' workflow in outpatient department of four typical clinical specialties was conducted. The record of workflow interruptions was based on a self-made observation instrument after verifying its reliability and validity. Linear regression methods were used to assess outpatient characteristics as predictors of the number of interruptions. The Kruskal-Wallis test was used to analyze the difference about the duration of interruptions among specialties, and the Chi-Square Test was used to examine the sources of interruptions among different specialties, to determine whether interruption source is associated with specialty.ResultsThe number of patients was the significant independent predictor of the number of interruptions (p < 0.001). In terms of work tasks being interrupted, the highest interruption rate occurred when physicians were asking health history: 19.95 interruptions per hour. The distribution of interruption sources among the four clinical specialties were statistically different (X2 = 16.988, p = 0.049).ConclusionThe findings indicate that physicians' workflow interruptions are connected with many contents in the work system. Further emphasis should be placed on the effective application of hospital management measures in an interrupted environment to promote a safe and efficiency outpatient care.