Strategies for interday appointment scheduling in primary care

Abstract

When faced with a medical problem, patients contact their primary care physician (PCP) first. Here mainly two types of patient requests occur: non-scheduled patients who are walk-ins without an appointment and scheduled patients with an appointment. Number and position of the scheduled appointments influence waiting times for patients, capacity for treatment and the utilization of PCPs. As the number of patient requests differs significantly between weekdays, the challenge is to match capacity with patient requests and provide as few appointment slots as necessary. In this way, capacity for walk-ins is maximized while overall capacity restrictions are met. Decisions as to the optimal appointment capacity per day on a tactical decision level has gained little attention in the literature. A mixed integer linear model is developed, where the minimum number of appointments scheduled for a weekly profile is determined. We are thus able to give the answer as to how many appointments to offer on each day in a week in order to create a schedule that takes patient preferences as well as PCP preferences into account. Appointment schedules are often influenced by uncertain demands due to the number of urgent patients, interarrivals and service times. Based on an exemplary case study, the advantages of the optimal appointment schedule on different performance criteria are shown by detailed stochastic simulations.

Stochastic integer programming for multi-disciplinary outpatient clinic planning

“…The multi-day focus concerns the percentage of appointment slots to reserve for open access patients [10,35,36,45,49], since this percentage influences amongst others the queue length and overtime [10]. Contrary to most available literature, Wiesche et al [49] consider flexible capacity, to cope with varying patient arrival rates during the week in a primary care clinic.…”

“…Contrary to most available literature, Wiesche et al [49] consider flexible capacity, to cope with varying patient arrival rates during the week in a primary care clinic. They use an integer programming approach to determine the optimal capacity, taking open access and regular patients into account, and evaluate the system performance by a stochastic simulation.…”

“…The intra-day focus concerns the sequence of fixed and open access appointments slots during the day [49], and the allocation of open access patients to appointment slots [4]. Since most authors evaluate multiple appointment sequences by a simulation study [e.g.…”

Organizing integrated processes in cancer care

“…The multi-day focus concerns the percentage of appointment slots to reserve for open access patients [89,248,249,290,322], since this percentage influences among others the queue length and overtime [89]. Contrary to most available literature, Wiesche et al [322] consider flexible capacity, to cope with varying patient arrival rates during the week in a primary care clinic.…”

“…Contrary to most available literature, Wiesche et al [322] consider flexible capacity, to cope with varying patient arrival rates during the week in a primary care clinic. They use an integer programming approach to determine the optimal capacity, taking open access and regular patients into account, and evaluate the system performance by a stochastic simulation.…”