Outpatient Appointment Optimization: A Case Study of a Chemotherapy Service

In this paper, we study a complex outpatient planning problem in the chemotherapy department. The planning concerns sequences of patients’ treatment sessions subject to exact in-between resting periods (i.e., exact time-lags). The planning is constrained by the hospital infrastructure and the availability of medical staff (i.e., multiple time-varying resources’ availability). In order to maximize the patients’ service quality, the objective of the function considered is to minimize the total wait times, which is equivalent to the criteria for minimizing the total completion time. Our main contribution is a thorough analysis of this problem, using the Hybrid Flow Shop problem as a theoretical framework to study the problem. A novel Mixed Integer Linear Programming (MILP) is introduced. Concerning the resolution methods, priority-based heuristics and an adapted genetic algorithm (GA) are presented. Numerical experiments are conducted on historical data to compare the performances of the approximate resolution methods against the MILP solved by CPLEX. Numerical results confirm the performances of the proposed methods.

SP10.2.10Efficacy of Outpatient Appointment Reminders in Colorectal Surgery: A Prospective Analysis

Introduction There is increasing mandate to improve attendance in outpatient clinics to support delivery of High-Quality Care. Non-attendance in Colorectal Cancer (CRC) has clinical and financial implications. Patient appointment reminders (letters, text-messages and telephone) have been implemented to reduce non-attendance. We examine the efficacy of patient appointment reminders in CRC patients. Methods A prospective study was conducted for 3-months in our CRC department surveying patients on their appointment reminders. Non-attending patients were surveyed via telephone to ascertain cause of non-attendance and preference of patient reminders. Data collected was analysed on SPSS. Results 547 patients were prospectively surveyed. 19% did not receive appointments letters, from which 73% were made aware via Text message and 25% via Phone calls. 50% received letters > 2 weeks’ notice. 183 patients did not attend (DNA) their appointment from which 100 were successfully surveyed through telephone. 60% of patients did not received an appointment reminder (letter), or received it following the date of their appointment. 79% patients preferred to be contacted via text messaging or an appointment app vs 13% via letters. Cost analysis releveled significant losses due to missed appointments. Conclusion Patient appointment reminders are fundamental in reducing non-attendance in clinics. Our study demonstrates that appointment letters are an unreliable method of patient communication. In an ever-increasing digital age, methods such as timely text-messages or an appointment app for CRC patients’ needs urgent implementation as per patient preferences. Further research is required to assess non-attendance and causality in other specialities for comparison.

Exploring Subconscious Bias

Background: Implicit biases involve subconscious associations that lead to a negative evaluation of a person based on irrelevant characteristics such as race or gender. This audit of management of patients who missed appointments investigates the presence of implicit bias in our unit. Methods: We retrospectively analysed discharge rates in 285 patients who missed an outpatient appointment between from 1/4/2020 at Guy’s and St Thomas’ Hospital. 285 patients were categorised into predefined ethnic categories: White British (WB) vs Black, Asian and Minority Ethnic (BAME) vs Other White (OW) after reading the patient’s names. In the same fashion, we also assigned gender. Results: We did not find differences in discharge rates among self-reported ethnic and gender groups. Patients with WB sounding names were more likely to be discharged when compared to patients with BAME sounding names (35% vs 58%). Discharge rates between males and females did not differ. Conclusion: Our results suggest that implicit bias may play a role in decision-making whether to rebook a patient after missing an appointment.

About the development of bone tissue in goiter

In May 1921, a patient with a significant goiter came to the Faculty Surgical Clinic of Kazan University for an outpatient appointment with a request for an operation. The patient was admitted to the clinic, and in view of the rare and extremely interesting features that the goiter presented in her during its objective study, this case was kindly provided to me by the then temporarily in charge of the clinic, prof. VN Larin for research and description.

DISTRIBUTION BY GENDER AND AGE OF PATIENTS WITH CHRONIC GENERALIZED PERIODONTITIS IN THE THERAPEUTIC DEPARTMENT OF THE CLINIC OF DENTISTRY OF THE MILITARY MEDICAL ACADEMY NAMED AFTER S. M. KIROV

As an outpatient appointment, 347 patients (185 men and 162 women) who first sought dental care for chronic generalized periodontitis were examined in the therapeutic department of the Dentistry clinic of the Kirov Military Medical Academy. All patients were divided into three age groups: 40-45 years, 46-50 years, 51-55 years. There were no patients younger than 40 years old and older than 55 years old among the examined ones. When analyzing the results of the examination of patients, it was revealed that the largest number of patients belongs to the age group of 40-45 years (49.3±2.7% of all examined), on the second place was the age group of 46-50 years – 127 (36.6±2.6% of all examined) people (p<0.001), the smallest the group of patients was 51-55 years, 49 (14.2±1.9% of all examined) people (p<0.001). There were no large differences in the number of patients by gender between the age groups (p>0.05). Mild chronic generalized periodontitis prevails among the examined patients (65.1±2.6%, p<0.001). The mild severity of chronic generalized periodontitis was recorded in 121 (65.4±3.5%) of the 185 men, among 162 women – in 106 (64.8±3.8%). Chronic generalized periodontitis of moderate severity was detected in 42 (22.7±3.1%) men and 38 (23.5±3.3%) women. Finally, 22 (11.9±2.4%) men and 19 (11.7±2.5%) women went to the therapeutic department of the dental clinic with severe chronic generalized periodontitis. Thus, there were no large differences between the sexes in the number of patients with different degrees of severity of chronic generalized periodontitis (p>0.05).

Initial drug prescription in outpatient department: principal approach

One of the primary tasks for a doctor when meeting a patient for the first time is to gain his affection and trust. It is not always possible during the first visit to make an accurate diagnosis and prescribe pathogenetic therapy, because this often requires a deep additional examination. However, it is imperative to demonstrate knowledge and confidence, provide psychological support and alleviate the suffering of the patient, especially in the case of rheumatic disease accompanied by severe pain. Such a patient should be immediately prescribed adequate analgesic therapy. The main tool for controlling pain in diseases of the joints and spine are non-steroidal anti-inflammatory drugs. Moreover, their prescription should be deliberate and balanced, taking into account the clinical picture and comorbid pathology.The article presents two clinical observations, illustrating the formation of a diagnostic and therapeutic concept at an outpatient appointment.

Features of gastroenterologist’s work in COVID‑19 pandemic

The aim of the study was to determine the prevalence of organic and functional pathology at an outpatient appointment with a gastroenterologist before and during the COVID-19 pandemic. An assessment of 428 outpatient clinical cases over two periods was carried out. The analysis revealed a significant increase in functional gastrointestinal pathology. During the first study period, 36% of all applied patients had functional gastrointestinal diseases, in the second period the number of patients increased to 57%.The results obtained allow us to conclude that, despite the fact that COVID-19 affects the digestive organs along with the respiratory tract, the forced isolation that arose during the pandemic and general anxiety significantly increased the growth of the functional pathology of the gastrointestinal tract, which should be taken into account when developing treatment regimens and managing gastroenterological patients.