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Using Computer Simulation for Reducing the Appointment Lead-Time in a Public Pediatric Outpatient Department

  • Miguel Ortiz-BarriosEmail author
  • Genett Jiménez-Delgado
  • Sally McClean
  • Giselle Polifroni-Avendaño
Conference paper
Part of the Lecture Notes in Computer Science book series (LNCS, volume 11582)

Abstract

Pediatric outpatient departments aim to provide a pleasant, effective and continuing care to children. However, a problem in these units is the long waiting time for children to receive an appointment. Prolonged appointment lead-time remains a global challenge since it results in delayed diagnosis and treatment causing increased morbidity and dissatisfaction. Additionally, it leads to an increased number of hospitalization and emergency department visits which augments the financial burden faced by healthcare systems. Despite these considerations, the studies directly concentrating on the reduction of appointment lead-time in these departments are largely limited. Therefore, this paper proposes the application of Discrete-event Simulation (DES) approach to evaluate potential improvement strategies aiming at reducing average appointment lead-time. Initially, the outpatient department is characterized to effectively identify the main activities, process variables, interactions, and system constraints. After data collection, input analysis is conducted through intra-variable independence, homogeneity and goodness-of-fit tests followed by the creation of a simulation model representing the real pediatric outpatient department. Then, Mann-Whitney tests are used to prove whether the model was statistically comparable with the real-world system. After this, the outpatient department performance is assessed in terms of average appointment lead-time and resource utilization. Finally, three improvement scenarios are assessed technically and financially, to determine if they are viable for implementation. A case study of a mixed-patient type environment in a public pediatric outpatient department has been explored to validate the proposed methodology. Statistical tests demonstrate that appointment lead-time in pediatric outpatient departments may be meaningfully minimized using this approach.

Keywords

Discrete-event simulation (DES) Healthcare Appointment lead-time Pediatric Outpatient care 

References

  1. 1.
    Oche, M.O., Adamu, H.: Determinants of patient waiting time in the general outpatient department of a tertiary health institution in north Western Nigeria. Ann. Med. Health Sci. Res. 3(4), 588–592 (2013)CrossRefGoogle Scholar
  2. 2.
    Wright, J.G., et al.: Development of pediatric wait time access targets. Can. J. Surg. 54(2), 107 (2011)CrossRefGoogle Scholar
  3. 3.
    Tan, J.H.T., et al.: A quality improvement project to reduce waiting time for pediatric outpatient referral clinics in Singapore. Proc. Singap. Healthcare 26(4), 224–229 (2017)CrossRefGoogle Scholar
  4. 4.
    Günal, M.M., Pidd, M.: Discrete event simulation for performance modelling in health care: a review of the literature. J. Simul. 4(1), 42–51 (2010)CrossRefGoogle Scholar
  5. 5.
    Aeenparast, A., Tabibi, S.J., Shahanaghi, K., Aryanejhad, M.B.: Reducing outpatient waiting time: a simulation modeling approach. Iran. Red Crescent Med. J. 15(9), 865 (2013)CrossRefGoogle Scholar
  6. 6.
    Jamjoom, A., Abdullah, M., Abulkhair, M., Alghamdi, T., Mogbil, A.: Improving outpatient waiting time using simulation approach. In: 2014 European Modelling Symposium, pp. 117–125. IEEE, October 2014Google Scholar
  7. 7.
    Bean, D.M., Taylor, P., Dobson, R.J.: A patient flow simulator for healthcare management education. BMJ Simul. Technol. Enhanc. Learn. 5(1), 46–48 (2019)CrossRefGoogle Scholar
  8. 8.
    Ortiz, M.A., López-Meza, P.: Using computer simulation to improve patient flow at an outpatient internal medicine department. In: García, C.R., Caballero-Gil, P., Burmester, M., Quesada-Arencibia, A. (eds.) UCAmI 2016. LNCS, vol. 10069, pp. 294–299. Springer, Cham (2016).  https://doi.org/10.1007/978-3-319-48746-5_30CrossRefGoogle Scholar
  9. 9.
    Ortiz, M.A., McClean, S., Nugent, C.D., Castillo, A.: Reducing appointment lead-time in an outpatient department of gynecology and obstetrics through discrete-event simulation: a case study. In: García, C.R., Caballero-Gil, P., Burmester, M., Quesada-Arencibia, A. (eds.) UCAmI 2016. LNCS, vol. 10069, pp. 274–285. Springer, Cham (2016).  https://doi.org/10.1007/978-3-319-48746-5_28CrossRefGoogle Scholar
  10. 10.
    Constitución Política de Colombia (1991). http://www.secretariasenado.gov.co/index.php/constitucion-politica
  11. 11.
    Congreso de la República de Colombia: Ley 1751 de 2015. Por medio de la cual se regula el derecho fundamental a la salud y se dictan otras disposiciones, 16 February 2015. http://www.secretariasenado.gov.co/senado/basedoc/ley_1751_2015.html#26
  12. 12.
    Ministerio de Salud y Protección Social: Resolución 429 de 2016. Por medio de la cual se adopta la Política de Atención Integral en Salud, 17 February 2016. https://www.minsalud.gov.co/Normatividad_Nuevo/Resoluci%C3%B3n%200429%20de%202016.pdf
  13. 13.
    Ministerio de Salud y Protección Social: Resolución 3202 de 2016. Por la cual se adopta el Manual Metodológico para la elaboración e implementación de las Rutas Integrales de Atención en Salud — RIAS, se adopta un grupo de Rutas Integrales de Atención en Salud desarrolladas por el Ministerio de Salud y Protección Social dentro de la política de Atención Integral en Salud —PAIS y se dictan otras disposiciones, 25 July 2016. https://www.minsalud.gov.co/Normatividad_Nuevo/Reluci%C3%B3n%203202%20de%202016.pdf
  14. 14.
    Izquierdo, N.V., Viloria, A., Lezama, O.B.P., Gaitán-Angulo, M., Herrera, H.H.: Performance evaluation by means of fuzzy mathematics. The case of a clinical laboratory. J. Control Theory Appl. (2016). ISSN 0974–5572Google Scholar
  15. 15.
    Mohiuddin, S., et al.: Patient flow within UK emergency departments: a systematic review of the use of computer simulation modelling methods. BMJ Open 7(5), e015007 (2017)CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Miguel Ortiz-Barrios
    • 1
    Email author
  • Genett Jiménez-Delgado
    • 2
  • Sally McClean
    • 3
  • Giselle Polifroni-Avendaño
    • 4
  1. 1.Department of Industrial Management, Agroindustry and OperationsUniversidad de La Costa CUCBarranquillaColombia
  2. 2.Department of Engineering in Industrial Process EngineeringInstitución Universitaria ITSABarranquillaColombia
  3. 3.School of ComputingUniversity of UlsterLondonderryUK
  4. 4.Department of General ManagementSofast Ingeniería S.A.S.BarranquillaColombia

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