NDLI: Criteria-based outpatient scheduling at a nephrology clinic: prospective evaluation of patient pre-assessment and its corresponding adaptive scheduling strategy

Content Provider	Springer Nature : BioMed Central
Author	Klaas, Ruben Lok-Visser, Jedidja Doornebal, Joan Roelofs, Ton Rachuba, Sebastian Leeftink, Gréanne
Abstract	Outpatient Clinics (OCs) are under pressure because of increasing patient volumes and provider shortages. At the same time, many patients with chronic diseases receive routine follow-up consultations that are not always necessary. These patients block access to care for patients that are in actual need for care. Pre-assessing patient charts has shown to reduce unnecessary outpatient visits. However, the resulting late cancellations due to the pre-assessment, challenge efficient alignment of capacity with actual patient demand, leading to either empty slots or overtime. This study aims to develop a method to analyse the effect of pre-assessing patients before inviting them to the OC. This involves 1) to select who should come and 2) to optimize the impact of pre-assessment on the schedule and efficient use of OC staff. This prospective mixed-methods evaluation study consists of 1) an expert meeting to determine a pre-assessment strategy; 2) a retrospective cohort study to review the impact of this strategy (12 months of a Dutch nephrology OC); 3) mathematical optimization to develop an optimal criteria-based scheduling strategy; and 4) a computer simulation to evaluate the developed strategy. Primary outcomes are the staff idle time and staff overtime. Secondary outcomes evaluate the number of weekly offered appointments. The expert group reached consensus about the pre-assessment criteria. 875 (18%) of the realized appointments in 2022 did not meet the OC visit pre-assessment criteria. In the best performing scheduling strategy, 94 slots (87% of the available capacity) should be scheduled on a weekly basis. For this schedule, 26.8% of the OC weeks will experience idle time ( $\mu$ =2.51, $\sigma$ =1.44 appointment slots), and 21% of the OC weeks will experience overtime ( $\mu$ =2.26, $\sigma$ =1.65 appointment slots) due to the variation in patient appointment requests. Using the pre-assessment strategy combined with the best performing scheduling strategy under full capacity (108 slots), up to 20% increase in patient demand can be handled with equal operational performance. This evaluation study allows OC managers to virtually test operational impact of pre-assessment strategies on the capacity of their OC, and shows the potential of increasing efficient use of scarce healthcare capacity. Not applicable.
Related Links	https://bmchealthservres.biomedcentral.com/counter/pdf/10.1186/s12913-024-11615-7.pdf
Ending Page	10
Page Count	10
Starting Page	1
File Format	HTM / HTML
ISSN	14726963
DOI	10.1186/s12913-024-11615-7
Journal	BMC Health Services Research
Issue Number	1
Volume Number	24
Language	English
Publisher	BioMed Central
Publisher Date	2024-09-28
Access Restriction	Open
Subject Keyword	Public Health Health Administration Health Informatics Nursing Research Outpatient clinics Planning & scheduling Appointments Patient flow Avoidable assessments Pre-assessment
Content Type	Text
Resource Type	Article
Subject	Health Policy

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1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
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