Ancillary service impact on outpatient scheduling

Purpose: The paper aims to provide a simulation optimization solution to improve patient scheduling that accounts for varying ancillary service time such as x-ray to minimize patient wait time. Design/methodology/approach: The two-step approach is to: identify patients' needs for ancillary services while scheduling appointments; and propose an algorithm to determine ancillary service time via simulation optimization. The main aim is to provide sufficient time between arrival at the clinic and the actual examination time for a patient to complete pre-visit activities without contributing significantly to patient wait time. Two case studies are included to demonstrate the approach. Findings: Triaging at the appointment-scheduling time saves an average 17 minutes for physician's first consultation in a clinic day, and a 7 percent reduction on current average patient wait time for case 1. Case 2 results in a 9 percent reduction on average patient wait time. The scheduled ancillary service time depends on the frequency and the ancillary service time, and appointment slot design. Research limitations/implications: One limitation is the impact of modeling error on the account of ancillary service times and the modeling assumptions. Practical implications: The proposed approach provides a studying method for clinic staff to account for ancillary services prior to physicians' visits for a better patient care. Two case studies demonstrated the practicability and promising results on reducing patient waiting. Originality/value: This article presents a unique approach to considering the required ancillary services in outpatient scheduling system that minimizes patient wait times. The approach will strengthen the existing scheduling methods to allow the time for ancillary services.