Criteria-based outpatient scheduling at a nephrology clinic: a pre-assessment and adaptive scheduling intervention
Jedidja Lok-Visser (BMS-CHOIR, Isala Clinics), Ruben Klaas (BMS-CHOIR, Isala Clinics), Joan Doornebal (Isala Clinics), Ton Roelofs (Isala Clinics), Sebastian Rachuba (BMS-CHOIR), Gréanne Leeftink (BMS-CHOIR)
Abstract
Outpatient clinics (OCs) are under pressure due to increasing healthcare demand and healthcare provider shortages. In order to deal with this pressure, pre-assessing the necessity of routing follow-up consultations of chronic patients could result in more available appointment slots for patients actually need care. However, this also increases the variability of the number of follow-up consultations, leading to either empty slots or overtime.
This study aims to create a pre-assessment methodology, and analyze the impact of this methodology on the efficient scheduling of OC staff.
This mixed-methods evaluation study consists of (i) an expert meeting to determine the pre-assessment strategy, (ii) a retrospective cohort study to review the impact of this strategy (12 months of a Dutch nephrology OC), (iii) mathematical optimization to develop a fitting scheduling strategy, and (iv) a computer simulation to evaluate this intervention.
The pre-assessment strategy developed by the expert group resulted in 875 appointments (18%) that did not meet the criteria. In the best performing scheduling strategy, 94 out of 108 appointment slots should be scheduled on a weekly basis. Due to weekly variation in appointment requests, this schedule results in 27% and 21% of OC weeks with empty slots and overtime, respectively. Using this pre-assessment strategy combined with the best performing scheduling strategy, the current OC capacity could handle up to 20% increase in patient demand.
This evaluation study allows OC managers to virtually test the impact of potential pre-assessment strategies on the capacity of their OC, and shows the potential of these strategies.