Coordinating clinic and surgery appointments to meet access service levels for elective surgery

• Published in: Journal of biomedical informatics Vol. 66; pp. 105 - 115
• Main Authors: Kazemian, Pooyan, Sir, Mustafa Y., Van Oyen, Mark P., Lovely, Jenna K., Larson, David W., Pasupathy, Kalyan S.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2017
• Subjects: Access to care; Appointments and Schedules; Clinic appointment scheduling; Computer Simulation; Coordinated care delivery; Discrete-event simulation; Elective Surgical Procedures; Female; Humans; Male; Models, Statistical; Operating Rooms; Surgery scheduling; Wait time target; Wait time target; Surgery scheduling; Access to care; Discrete-event simulation; Clinic appointment scheduling; Coordinated care delivery
• ISSN: 1532-0464; 1532-0480
• DOI: 10.1016/j.jbi.2016.11.007

[Display omitted] •Coordinating surgeon’s clinic and surgery availability can improve patient access.•Pooling multiple surgeon calendars can improve operating room utilization.•Patients prioritized based on medical indications with varying access time targets.•Reduced operating room overtime by 52 percent at the same access service level. Providing timely access to surgery is crucial for patients with high acuity diseases like cancer. We present a methodological framework to make efficient use of scarce resources including surgeons, operating rooms, and clinic appointment slots with a goal of coordinating clinic and surgery appointments so that patients with different acuity levels can see a surgeon in the clinic and schedule their surgery within a maximum wait time target that is clinically safe for them. We propose six heuristic scheduling policies with two underlying ideas behind them: (1) proactively book a tentative surgery day along with the clinic appointment at the time an appointment request is received, and (2) intelligently space out clinic and surgery appointments such that if the patient does not need his/her surgery appointment there is sufficient time to offer it to another patient. A 2-stage stochastic discrete-event simulation approach is employed to evaluate the six scheduling policies. In the first stage of the simulation, the heuristic policies are compared in terms of the average operating room (OR) overtime per day. The second stage involves fine-tuning the most-effective policy. A case study of the division of colorectal surgery (CRS) at the Mayo Clinic confirms that all six policies outperform the current scheduling protocol by a large margin. Numerical results demonstrate that the final policy, which we refer to as Coordinated Appointment Scheduling Policy considering Indication and Resources (CASPIR), performs 52% better than the current scheduling policy in terms of the average OR overtime per day under the same access service level. In conclusion, surgical divisions desiring stratified patient urgency classes should consider using scheduling policies that take the surgical availability of surgeons, patients’ demographics and indication of disease into consideration when scheduling a clinic consultation appointment.