A hybrid simulation and genetic algorithm approach to determine the optimal scheduling templates for open access clinics admitting walk-in patients

With the pressing demand for improving patient accessibility, the traditional scheduling system may not be effective for mitigating the adverse effects caused by no-shows, appointment cancellations and late arrivals. For this reason, open access scheduling, which specifies that a portion of clinic appointment slots be reserved for short-notice appointments, was proposed and adopted in recent years. In literature, many studies have developed a variety of approaches and models to optimize the open access scheduling systems, while few considers the inclusion of walk-in patients and the optimal allocation of reserved slots on the scheduling template under the open access configuration. In this paper, we propose a Discrete Event Simulation and Genetic Algorithm (DES-GA) approach to find the heuristic optimal scheduling template under the clinic setting that allows both open access and walk-in patients. The solution can provide scheduling templates consisting of not only the optimal number of reservations for open access appointments and walk-ins, but also the optimized allocation of these reserved slots, by minimizing the average cost per admission of open access or walk-in patient. In this approach, the cost is measured by the weighted summation of patient waiting time, provider idle time, and provider overtime. A case study and sensitivity analysis are conducted to show how the heuristic optimal scheduling template generated from the proposed approach could vary under different scenarios. This also illustrates the viability of our model. The results show that the heuristic optimal scheduling templates are significantly affected by the patient attendance rate, level of demands of same-day appointment and walk-in admissions, as well as the cost coefficients associated with patient waiting time, provider idle time and provider overtime. © 2014 Elsevier Ltd. All rights reserved.