Using Simulation Optimization to Solve Patient Appointment Scheduling and Examination Room Assignment Problems for Patients Undergoing Ultrasound Examination

This study investigates patient appointment scheduling and examination room assignment problems involving patients who undergo ultrasound examination with considerations of multiple examination rooms, multiple types of patients, multiple body parts to be examined, and special restrictions. Following are the recommended time intervals based on the findings of three scenarios in this study: In Scenario 1, the time interval recommended for patients’ arrival at the radiology department on the day of the examination is 18 min. In Scenario 2, it is best to assign patients to examination rooms based on weighted cumulative examination points. In Scenario 3, we recommend that three outpatients come to the radiology department every 18 min to undergo ultrasound examinations; the number of inpatients and emergency patients arriving for ultrasound examination is consistent with the original time interval distribution. Simulation optimization may provide solutions to the problems of appointment scheduling and examination room assignment problems to balance the workload of radiological technologists, maintain high equipment utilization rates, and reduce waiting times for patients undergoing ultrasound examination.

Effects of COVID-19 pandemic on ART Service delivery: perspectives of healthcare workers in a Teaching Hospital in Ghana

Background Ghana has a generalized HIV epidemic and efforts have been made to curb the spread and reverse its effects on the general population. In the wake of COVID-19 pandemic, the health system was unsettled and antiretroviral therapy (ART) care has been impacted in diverse ways. The study sought to explore the effects of COVID-19 on ART service provision in Ghana from the perspectives of the healthcare workers. Methods An exploratory-descriptive qualitative approach was employed in this study. Using maximum variation sampling method, fifteen healthcare workers; nurses, data managers and pharmacists were recruited from an ART clinic in a Teaching Hospital in Ghana. In-depth interviews were conducted and analysed using Braun and Clarke thematic approach. Results Three themes emerged from the data; “… And the pandemic struck”, “Impact of the pandemic on ART service delivery”; “Effecting the needed change”. The healthcare workers’ initial reactions to the pandemic and their show of commitment in ensuring continued ART service was evident. COVID-19 impacted service delivery in three main ways; (1) clients’ clinic attendance was erratic at various stages of the pandemic, (2) irregular resource availability as shortage was reported due to affected last mile delivery as a result of the lockdown in Accra, and (3) the health worker-patient interaction became less engaging because of established COVID-19 protocols. The healthcare workers however instituted strategies such as adjusting the patient appointment schedule, health professionals’ work schedule, establishing several work stations, task-shifting, and ensuring the implementation of all the COVID-19 protocols within the ART unit to ensure consistent service delivery as well as patient and staff safety. The study also found a decline in the implementation of several strategies established in the ART clinic during the initial phases of the pandemic such as a decline in the supply of Personal Protective Equipment (PPEs) by hospital management. Conclusions Although several strategies were implemented to manage the effects of the pandemic on ART care, there is a need to establish pathways of support for healthcare workers within the ART clinic and to consolidate as well as institutionalise the changes that ensured continuous but safe service delivery.

Quick Response Code Based Online Appointment Scheduling System: An Approach towards Health Management

For day to day functioning of healthcare services in healthcare sector there is requirement of managing, tracking and keeping patient appointment and medication related information in a effective and efficient way. If a person is suffering from any disease and needs to visit a doctor in a hospital for checkup the patient required to fill hospital registration form in hospital and waits in a long queue while getting an appointment. In some hospitals online appointments can be done by web or smart phone application. Some of these existing applications do not provide information regarding doctor availability, and do not provide patients medical records, etc. This paper proposes a web based application to overcome drawbacks related to existing appointment systems. In this paper the web application will provide a unique QR code to each patient, at the time the patient takes an online appointment for the doctor. The study provides an efficient way of managing health care accessibility in future.

Patient Decision and Experience in the Multi-channel Appointment Context: An Empirical Study (Preprint)

BACKGROUND Long waiting time for treatment in the outpatient department has long been a complaint and influence patient experience. It is critical to schedule patients for doctors to reduce patient waiting time. Nowadays, the multi-channel appointment has been provided for patients to get medical services, especially for those with severe illnesses and remote distance. OBJECTIVE This study aims to explore the factors influencing patient appointment channel choice in the context of multi-channel appointments, and how channel choice affects the waiting time for offline visiting. METHODS We collected outpatient appointment records from both online and offline appointment channels to conduct our empirical research. The empirical analysis is conducted into two steps. We first analyze the relationship between appointment channel choice and patient waiting time, and then the relationships between three determinants and appointment channel choice. The ordinary least squares and the logistic regression model are used to obtain empirical results. RESULTS Our results show that a patient with an online appointment decision has a shorter consultation waiting time compared with a patient with on-site appointment (β = -0.320, p<0.001). High-quality resource demand (β = 0.349, p<0.001), high-severity disease (β = 0.011, p<0.001), and high non-disease costs (β = 0.039, p<0.001) create an obvious incentive for patients to make appointments via the Internet. Further, only the effect of non-disease cost on channel choice is lower for patients with multiple visit histories (β = -0.021, p<0.001). CONCLUSIONS Our study confirms the effect of Internet use on reducing patient waiting time. Patients consider both health-related risk factors and cost-related risk factors to make decisions on appointment channels. Our study produces several insights, which have implications for channel choice and patient behavior literature. More importantly, these insights as a whole, contribute to the design of appointment systems of hospitals.

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 &gt; 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.

Clinical audit on possible causes of hospital initiated clinic cancellations and recommendation to improve the service

AimsThe aim of this audit is to explore the possible causes of clinic cancellation in an inner city CMHT and the recommendation to reduce the burden.BackgroundCancellations of planned appointments have been a major and long-standing problem for healthcare organisations across the world. It represents a significant loss of revenue and waste of resources, have significant psychological, social and financial implications for patients and their families and represent a significant loss of training opportunities for trainees. Re-scheduling appointment is one of the major issues of inconvenience to the patients. It also increases workload for the patient appointment team.MethodData have been collected retrospectively from patient appointment booking team regarding clinic cancellation with causes of cancellation recorded in the system (01/07/2019–30/09/2019). The investigators have investigated if the cancellation has been made when it was absolutely necessary to cancel the clinic (Unavailability of doctors due to leave/on calls) and if patients have been informed at least 8 weeks prior to the appointed clinic as per trust protocol.ResultTotal number of 193 clinics were booked at the CMHT from July 2019 – September 2019. About 54% clinics were cancelled during the time period. The Clinic Cancellation rate was higher in September (68%) and was lowest in August (30.30%). As the month of July is the changeover period for trainees, the number of clinics booked during August was relatively less than normal. 72% clinics were cancelled by junior doctors and 28% clinics were cancelled by consultants at the CMHT. The major cause of clinic cancellation was unavailability of the junior doctors due to on call (31.58%) which was not communicated to the patient appointment booking team. Due to annual leave, 25% clinics were cancelled and 21% clinics were cancelled due to study leave. In both cases it is evident that, lack of communication between clinicians and patient appointment team are primarily responsible for hospital-initiated clinic cancellations. As per Patient Appointment booking team, around 50% cases, patients were informed 8 weeks in advance before cancelling the clinics.ConclusionThis is evident from this audit that the number of hospital-initiated clinic cancellations can be reduced by improving communication between Patient Appointment booking service, Medical staffing department and clinicians. The findings of the audit have been shared locally with CMHT managers, clinicians and with the patient appointment booking team.