Managing interruptions in appointment schedules via patient notification

Abstract

Interruptions in appointment schedules are common in practice, yet many clinics use generic appointment scheduling templates and sub-optimal interruption management strategies that fail to address dynamics aspects of daily healthcare operations. In this study, we consider patient no-shows, patient punctuality, service time variability, random walk-in patient arrivals and other common appointment interruptions to determine optimal single-server, intra-day appointment schedules. Using a modified depth first search (DFS) algorithm that relies on a sample average approximation (SAA) technique for objective function evaluation, we minimize a weighted sum of expected waiting times for scheduled and walk-in patients, physician idle time, and physician overtime. Extensive experimentation shows the proposed algorithm solves realistic problems in reasonable time. Furthermore, we propose a sequential notification procedure (SNP) that serves as a dynamic correcting mechanism to address infrequent and unexpected interruptions with a relatively long duration. Considering possible patient responses to notification, SNP notifies scheduled patients in advance to prevent excessive patient waiting and physician overtime. Furthermore, we propose an easy-to-use patient notification heuristic (NH) that can be adopted by clinics using traditional appointment systems. Experimentation shows that both SNP and NH provide significant value, improving operational outcomes. We demonstrate the value of patient notification increases as interruption levels increase and when patients are responsive to notifications.