Managing Clinical Appointments in an Academic Medical Center

Abstract

According to the US Department of Health and Human Services, roughly 40% of all outpatient visits in the US are made to teaching hospitals. The educational mission of these settings adds stages to the care delivery process and, in some instances leads to a system which is a hybrid between a single and two-server queue. We consider the problem of determining appointment schedules for these settings which explicitly account for the teaching mission, high no-show rate, a blending of patient types, highly variable processing times, processing in multiple stages, processing times that are not independent across stages, and a dynamic policy regarding the involvement of a medical trainee. We formulate the resulting problem and develop structural results. We then use properties of the optimization problem to develop an intuitive Cyclic scheduling approach, which bundles multiple patients into each Cycle. The application of our modeling framework is illustrated for the AMC clinic that motivated this work.