Open Access Appointment Scheduling—An Experience At A Community Clinic (original) (raw)

Abstract

This study concerns the execution of open access appointment scheduling system at an urban outpatient clinic. The clinic underwent a change of its patient appointment scheduling policy from the traditional up-to-one- year fixed booking to the same-day appointment open access system. In this study, we developed a queueing network and a simulation model that help the decision making process of the clinic's scheduling policy. From the analytical results and anecdotal evidence, we also discovered the important factors for successfully implementing of open access. Large outpatient healthcare clinics schedule thousands of patient appointments each year, and the effectiveness of processes used have direct and critical impacts on the efficiency of clinical resource use and patient satisfaction. It is not unusual in traditional scheduling systems for appointments to be made months in advance of the patient visit, even when the clinic supply and demand are balanced in the sense that the number of new appointments scheduled equals the number of visits completed each day. Furthermore, no-show patients, who fail to report at their scheduled time, may number as much as 42% of the total which introduces enormous volatility in clinic operations that squanders critical availability of physicians and other clinical staff.(1) Open Access Scheduling has been introduced in the past decade to address some of these challenges. Instead of booking well ahead, a substantial fraction of patients are asked to call in for appointments within a day or two of the time they wish to see their physician. If appointment slots are available the patient is scheduled immediately, thus avoiding the long delay of advanced booking and substantially reducing no-shows in many settings. Despite its apparent appeal, implementations of open access scheduling often fail or prove far less successful than anticipated because the system has not been optimized for the environment in the particular clinic tested. For example, indigent or aged patients may have much more difficulty with some forms of open access than more up- scale populations. Work patterns of physicians - especially when residents are included - may prevent or complicate the ability of open access scheduling to preserve continuity of care between the patient and his/her regular doctor. Also, a certain fraction of patients, such as those returning for follow-up visits, may require advance appointments like the traditional system; the number of slots reserved for such patients must be optimized for different settings. This paper details the development of modeling and analysis tools that are used to best configure an open access patient scheduling system for an outpatient clinic of a teaching hospital situated in Midwest urban area. In the spring of 2005, the clinic was experiencing an average of 23% of patients defaulting on scheduled appointments. A nearby outpatient clinic successfully implemented an open access scheduling system and saw both patient no-show rates and wait times decrease, prompting the clinic under study to consider open access. We were approached by the teaching clinic to help develop a tool for analyzing an open access setting for their clinic. Our approach consisted of developing a queueing network model to analyze clinic operation under steady state conditions. A simulation model evaluating an open access scheduling system parameters was developed in parallel to determine the impact of various factors on the delivery of care. The subsequent sections of this paper include a literature review, methodologies used in the study, an analysis of results and the current status of the clinic.

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