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MOTIVATION
Outpatient clinics: traditionally organized by
appointment systems
Major drawback: access time
Advantages walk-in: eliminate access time, one stop
shop, free choice for patient, no planned idle time
Logistical implications unknown: peaks in
congestion, idleness, not applicable to all patients?
BALANCING WALK-IN AND APPOINTMENTS
IN HEALTH CARE
N. Kortbeek, M.E. Zonderland, R.J. Boucherie, N. Litvak; Department of Stochastic Operations Research,
University of Twente; E-mail: [email protected]
GOAL
Design a methodology by which a specific outpatient clinic can decide upon its access policy, consisting of
1. Percentage of walk-in patients to defer to appointment slots: L
2. (a) The best capacity cycle, i.e. the distribution of appointment slots over period D (e.g. a week):
(k1,...,kD)
(b) Given (a), the best appointment day schedule
(Z1,...,ZD)
that satisfies a pre-specified access time norm for ap-pointment patients and minimizes L.
KEY-IDEA
Appointments: balance fluctuation by avoiding peaks
Offer walk-in patients appointment when congested
APPROACH
Techniques:
Step 2: Probability generating function approach
Step 3: Markov reward process
1
0 0
( ) ( ) ( ) ( ) ( )
d jkd d d
i q
j a j i a j q k q
d+1 d d
1 1( , ) ( , ) | ( , ) ( , )t t t tk l
Q s u P s u k l Q k l
RESULTS
A cyclic schedule that maximizes walk-ins seen same
day, without harming the appointment patients
A generic tool by which managements of different
outpatient clinics can evaluate trade-offs and thereby determine their preferred strategy
PRACTICAL IMPLICATIONS
Case study CT Scanner AMC Amsterdam
Now
Waiting list → Delay in care pathway
Delay → Deterioration of health condition
Deterioration of health condition → Costs increase
Future
Delay from >5 days to <1.5 on average
Freedom for patients
One stop shop
Implementation in preparation
