Appointment Scheduling Strategy Considering Walk-in And Urgent Patients

The increasing demand for high-quality medical services and the shortage of medical resources make balancing ability and demand one of the core challenges in medical and health care management,especially the variability and uncertainty of both,which makes the development of a reasonable outpatient appointment system an effective means to meet the management needs of many hospitals.In order to manage the supply-demand relationship,the hospital outpatient service uses the Appointment System(AS)to allocate a whole day's workload(demand)by arranging patients to a shorter time period called slot,which can more effectively synchronize doctors and other resources.However,some uncertainties will affect the reservation system,resulting in inefficient utilization of resources.For example,when a patient is no-show or is not on time,that is patients miss an appointment or arrives earlier or later than the appointment time without canceling it in advance.Early arrival of patients will lead to congestion in waiting area and increase waiting time of patients,which will reduce patients' satisfaction with service,and bring extra free time to doctors and reduce hospital outpatient efficiency.In the past literature,the high probability of no-show is considered to be the key factor to reduce the profit of the system.In order to reduce the negative impact of high no-show probability of appointment and better balance the limited medical resources,hospitals should consider scheduling different types of patients when designing a reasonable and effective appointment system,which can not only provide timely and convenient medical services for patients,but also improve the operation efficiency of hospitals while improving patient satisfaction.This study considers the scheduling problem of three types of patients:routine patients,urgent patients and walk-in patients.Due to the limited resources of the system,urgent patients and walk-in patients are potential appointment requests.Therefore,when scheduling routine appointment patients,resources should be reserved for these potential patients.Comparing the benefits and costs of scheduling urgent patients with routine patients,the optimal scheduling strategies for different types of patients are determined.The probability of no-show is different for different types of patients,assuming that the service time is exponentially distributed.Based on the above reservation scenario,a stochastic programming model is established.The objective function is to maximize the hospital's revenue,while the objective function takes into account the patient's waiting the overtime cost and the idle cost of the doctor.According to the objective function,an improved local search algorithm is proposed to determine the optimal scheduling for routine patients and the optimal reservation number and time period for urgent patients.The improved local search algorithm and the traditional heuristic algorithm are compared by numerical experiments.The influence of patient's no-show and demand uncertainty on the optimal expected revenue is analyzed by sensitivity analysis.The results show that the reservation and scheduling strategies of the proposed algorithm have better benefits than the traditional heuristic algorithm.In this study,three different types of patient scheduling simulation systems are considered through simulation.In the system,the factors such as patients' appointment preference,service priority of different patient groups,routine medical examination and secondary consultation are considered,and the total number of service personnel,patients' waiting time,service time and resource utilization efficiency of the system under five different doctor service time distributions are compared.For five different distributions,the results show that the waiting time and resource utilization rate of patients under exponential distribution and gamma distribution are lower,that is,when the uncertainty of doctors'service time is higher,the overall performance of the system is worse.In addition,for patients with higher priority,the average waiting time is less than that of walk-in patients,and the resource utilization of doctors with higher priority is also higher.