Summary
Background: Patient wait time is a critical element of access to care that has long been recognized
as a major problem in modern outpatient health care delivery systems. It impacts patient
and medical staff productivity, stress, quality and efficiency of medical care, as
well as health-care cost and availability.
Objectives: This study was conducted in a Women’s Health Clinic. The objective was to improve
clinic service quality by redesigning patient appointment template using the clinical
constraints.
Methods: The proposed scheduling template consisted of two key elements: the redesign of appointment
types and the determination of the length of time slots using defined constraints.
The reclassification technique was used for the redesign of appointment visit types
to capture service variation for scheduling purposes. Then, the appointment length
was determined by incorporating clinic constraints or goals, such as patient wait
time, physician idle time, overtime, finish time, lunch hours, when the last appointment
was scheduled, and the desired number of appointment slots, to converge the optimal
length of appointment slots for each visit type.
Results: The redesigned template was implemented and the results indicated a 73% reduction
in average patient waiting from the reported 40 to 11 minutes. The patient no-show
rate was reduced by 4% from 24% to 20%. The morning section on average finished about
11:50 am. The clinic day was finished around 4:45 pm. Provider average idle time was
estimated to be about 5 minutes, which can be used for charting/documenting patients.
Conclusions: This study provided an alternative method of redesigning appointment scheduling templates
using only the clinical constraints rather than the traditional way that required
an objective function. This paper also documented the employed methods step by step
in a real clinic setting. The implementation results concluded a significant improvement
on patient wait time and no-show rate.
Citation: Huang Y, Verduzco S. Appointment Template Redesign in a Women’s Health Clinic Using
Clinical Constraints to Improve Service Quality and Efficiency. Appl Clin Inf 2015;
6: 271–287
http://dx.doi.org/10.4338/ACI-2014-10-RA-0094
Keywords
Appointment scheduling - appointment template - reclassification - clinical constraints
