Reserving Capacity for Urgent Patients in Primary Care
Article first published online: 11 FEB 2011
© 2011 Production and Operations Management Society
Production and Operations Management
Volume 20, Issue 3, pages 456–473, May/June 2011
How to Cite
Dobson, G., Hasija, S. and Pinker, E. J. (2011), Reserving Capacity for Urgent Patients in Primary Care. Production and Operations Management, 20: 456–473. doi: 10.1111/j.1937-5956.2011.01227.x
- Issue published online: 13 MAY 2011
- Article first published online: 11 FEB 2011
- History: Received: October 2008; Accepted: August 2010, after 2 revisions.
- primary care;
- appointment scheduling;
- urgent patients
This paper examines the effect of the common practice of reserving slots for urgent patients in a primary health care practice on two service quality measures: the average number of urgent patients that are not handled during normal hours (either handled as overtime, referred to other physicians, or referred to the emergency room) and the average queue of non-urgent or routine patients. We formulate a stochastic model of appointment scheduling in a primary care practice. We conduct numerical experiments to optimize the performance of this system accounting for revenue and these two service quality measures as a function of the number of reserved slots for urgent patients. We compare traditional methods with the advanced-access system advocated by some physicians, in which urgent slots are not reserved, and evaluate the conditions under which alternative appointment scheduling mechanisms are optimal. Finally, we demonstrate the importance of patient arrival dynamics to their relative performance finding that encouraging routine patients to call for same-day appointments is a key ingredient for the success of advanced-access.