balancing walk-in and appointments in health care · case study ct scanner amc amsterdam waiting...

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: n.kortbeek@utwente.nl

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