1. To manage appointment calendars, an appointment scheduling system is used. Many appointment systems are available; these include single-block appointments, individual appointments, multiple-block appointments, and block/individual appointments. In this research paper two appointment systems are discussed in two different hospitals of ENT in Alexandria, hospital A and hospital B (Zaghloul & Enein, 2010). Two appointment systems described in the paper are sequential scheduling appointment system and the other is Hourly Block Appointment System. Out of A and B hospitals, Hourly Block Appointment System (HBAS) is used by hospital B for scheduling patients and the standard appointment system is used by the hospital A. This study was conducted in the 2nd week of January of the era 2010 as well as during the last week of March 2010. In Hourly Block Appointment System patients are examined in blocks and in the order they arrive (Zaghloul & Enein, 2010). In this system physician work for time when block of patient arrive and then continuous remain idle between the waves of patient. Here in this paper, as the hospital B was using the Hourly Block Appointment System, in every hour physician was examining around eight patients and examination of patients was carried out in the order of arrival of patients. Therefore, block size used in the hospital for Hourly Block Appointment System is eight.
2. For new cases, mean waiting time at the hospital A is given as 18.9 minutes and mean waiting time at the hospital B is 27.5 minutes. Hospital A was using the sequential scheduling appointment system while the hospital B was using the Hourly Block Appointment System. Therefore, it can be concluded from the derived results of the study that sequential scheduling appointment system used by hospital A has the less mean waiting time as compared to the Hourly Block Appointment System used by the hospital B. However this result was not corresponded with the previous study where it was found that the standard appointment system has prolonged mean waiting time as compared to the Hourly Block Appointment System. This was actually the result of crowding and overbooking due to the mismatching of time given to the patient for visiting and the time required by the patient to perform the visit and due to the fitting in patients between the walk-ins and emergency patients (Zaghloul & Enein, 2010).
3. It has been an important topic of research for healthcare providers to regulate the patient number in a particular time slot. Main aim of this research is to minimise the idle time in appointment scheduling. Idle time in appointment scheduling is defined as the time for which equipment, staff, and the resources of the hospital are not being used (Chen, Robielos, Palana, Valencia, & Chen, 2015). If a very few patients will be assigned by the scheduler then medical resources will be idle. However, if too many patients will be assigned in a particular time slot then patients have to wait for longer. Hence a trade-off between the patients’ waiting time and the machine’s idle time does exist (Nguyen, Sivakumar, & Graves, 2016). An effective appointment system should minimise the waiting time of patient and also minimise the idle time of medical resources. In Hourly Block Appointment System, many patients are being called at one time. Appointment intervals are set to seven for new patients and eight for return patients (Zaghloul & Enein, 2010). Hourly Block Appointment System works like a wavelike pattern. In this appointment system physician works continuously when patients arrive in block and then physician has a block of free time after attending all the patients or between the waves of patients. There is a ‘wait ratio’ approach given by Yu-Li Huang that balances the patient wait time and the physicians’ idle time. In this approach, optimal time intervals for new cases and the return cases are determined and then the schedule for the physician is developed. ‘Wait ratio’ concept has the advantage over the ‘cost ratio’ concept as it prevents from just being ‘physician centric’. While it is considered that wait time of patient and idle time of physician both leads to cost ratio but in real physician’s idle time cost is much higher than the patient wait time. Therefore while scheduling the patient time intervals, consider the cost ratio between the physician’s idle time and the patient’s wait time (Huang). Hence, wait ratio helps clinic to consider clinic constraints while developing appointment schedule for the better patient flow.
4. Access time is defined as the time duration or days after the request have made for an appointment. Scheduling patients is one of the most common and important task performed in the hospitals (Laan, Vrugt, Olsman, & Boucherie, 2017). It has a huge impact on the success of a hospital. A hospital put maximum efforts in order to keep the missed appointments to the minimum and make efforts in order to ensure that the patients come to the doctor for examination in their scheduled appointment time (InstituteofMedicine, 2015). But due to some reasons like there are some patients who always run behind, some emergency cases, and other unexpected events that causes disturbance in the scheduled appointments (Solutionreach, 2017). In hospital A, standard schedule appointment system is used and here from the study, the average access time for new and return cases is 12.2 and 14.5 respectively. In order to reduce the access time for hospital A, one may not be able to control how to make their patients come on-time for their scheduled appointments but there are other things on the staff side that can be improved to ensure the schedule stays fluid (Prachyl, 2018). There are many ways of reducing access time but here are the two ways for hospital A to reduce the access time:
Conclusion:
From the studies on two appointment systems Hourly Block Appointment System in hospital B and the standard schedule appointment system in hospital A, it was found from the derived results that the waiting time and the access time were more in the Hourly Block Appointment System for both new and return cases (Brandenburg, Gabow, Steele, Toussaint, & Tyson, 2015). Patients were also found dissatisfied with the longer waiting time and the waiting time in Hourly Block Appointment System was longer as compared to the standard appointment system that has moderate waiting time. From the study, it was found that patient scheduling is important factor that decides the success of a hospital and there is need of adopting an effective and efficient appointment system in order to improve the health practices. An efficient appointment system ensures patient satisfaction, physician productivity, and practice profits. There are also ways to improve the above two mentioned appointment systems. In answer three, ways of improving Hourly Block Appointment System are mentioned where instead of focusing on the cost ratio, Yu-Li Huang focuses on wait ratio. This concept improves the Hourly Block Appointment System without increasing the physician idle time and ensures the greater use of medical resources. Similarly, there are ways of improving standard schedule appointment system as described in the answer 5. Two suggestions for improving standard system are confirmation call for pre scheduled patients and the appointment system should be patient centric.
Reference:
Brandenburg, L., Gabow, P., Steele, G., Toussaint, J., & Tyson, B. J. (2015). Innovation and Best Practices for Health Care Scheduling. Institute of Medicine of the National Academies.
Chen, P.-S., Robielos, R. A., Palana, P. K., Valencia, P. L., & Chen, G. Y.-H. (2015). Scheduling Patients’ Appointments: Allocation of Healthcare Service Using Simulation Optimization. Journal of Healthcare Engineering, 6(2), 259-280.
Huang, Y.-L. (n.d.). An Appointment Order Outpatient Scheduling System that Improves Outpatient Experience.
InstituteofMedicine. (2015). Transforming Health Care Scheduling and Access: Getting to Now. National Academies Press.
KPMG. (2009). The Need for More Effective Patient- and Family-centred Care. Saskatchewan .
Laan, C., Vrugt, M. V., Olsman, J., & Boucherie, R. J. (2017). Static and Dynamic Appointment Scheduling to Improve Patient Access Time. Health Systems, 7(2), 148-159.
Nguyen, T.-B. T., Sivakumar, A. I., & Graves, S. C. (2016). Scheduling rules to achieve lead-time targets in outpatient appointment systems. Health Care Manag Sci.
Prachyl, D. (2018). 7 WAYS TO IMPROVE ACCESS AND REDUCE NO-SHOWS. Retrieved from https://www.studergroup.com/hardwired-results/hardwired-results-14/7-ways-to-improve-access-and-reduce-no-shows
Safetynetmedicalhome. (2013). Enhanced Access. Retrieved from https://www.safetynetmedicalhome.org/sites/default/files/Implementation-Guide-Enhanced-Access.pdf
Safetynetmedicalhome. (2018). Guide to Appointment Confirmation Calls. Retrieved from https://www.safetynetmedicalhome.org/sites/default/files/appointment-confirmation.pdf
Solutionreach. (2017). 6 Ways to Schedule Patients Effectively and Efficiently. Retrieved from https://www.solutionreach.com/blog/how-to-schedule-patients-effectively
Zaghloul, A. A., & Enein, N. Y. (2010). Hourly-block and standard patient scheduling systems at two private hospitals in Alexandria. Journal of Multidisciplinary Healthcare, 3, 225-232.
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