On prioritizing on-time arrivals in an outpatient clinic

ABSTRACT

Non-punctual medical clinic arrivals disrupt operations, create inefficiencies, and decrease service quality. This quality improvement project examined the effects of early and late patient arrivals. We explored different queuing discipline protocols, designed to reward and to promote on-time arrival behaviors, by optimizing patient schedule management within a given clinic's workday. The goal of our study was to design a queuing system that prioritizes patients who arrive on time for their scheduled appointments, before those who are late or very early, with the assumption that a patient who arrives late or very early disrupts a clinic's desired scheduling flow. Based on data collected in a cardiology clinic at the Veterans Administration Pittsburgh Healthcare System, four simulation models were built to reflect current clinic queuing protocols, parameterizing various percentages of empty clinic appointment slots, and set to a range of acceptable patient no-show thresholds. Multi-sample statistical comparisons highlight a simulation model, utilizing an M/G/1 queuing protocol, to demonstrate significant improvements over prior models. Our proposed Hybrid protocol rewards on-time arrivals, and penalizes patients who arrive late or very early for their scheduled appointments. Clinical patient management policies that reward patients who arrive on time or slightly early may encourage patients to arrive on time for scheduled appointments and improve overall service efficiency.

KEYWORDS:

• M/G/1 queuing
• non-punctual arrivals
• OR in-health services
• simulation