title: Reducing patient wait times and improving resource utilization at British Columbia Cancer Agency's ambulatory care unit through simulation.
abstract: We consider an ambulatory care unit (ACU) in a large cancer centre, where operational and resource utilization challenges led to overcrowding, excessive delays, and concerns regarding safety of critical patient care duties. We use simulation to analyze the simultaneous impact of operations, scheduling, and resource allocation on patient wait time, clinic overtime, and resource utilization. The impact of these factors has been studied before, but usually in isolation. Further, our model considers multiple clinics operating concurrently, and includes the extra burden of training residents and medical students during patient consults. Through scenario analyses we found that the best outcomes were obtained when not one but multiple changes were implemented simultaneously. We developed configurations that achieve a reduction of up to 70% in patient wait times and 25% in physical space requirements, with the same appointment volume. The key findings of the study are the importance of on time clinic start, the need for improved patient scheduling; and the potential improvements from allocating examination rooms flexibly and dynamically among individual clinics within each of the oncology programs. These findings are currently being evaluated for implementation by senior management.
authors.affiliation: British Columbia Cancer Agency, 600 West 10th Avenue, Vancouver, BC, Canada. psantibanez@bccancer.bc.ca
authors.forename: Pablo
authors.initials: P
authors.lastname: Santibáñez
authors.forename: Vincent S
authors.initials: VS
authors.lastname: Chow
authors.forename: John
authors.initials: J
authors.lastname: French
authors.forename: Martin L
authors.initials: ML
authors.lastname: Puterman
authors.forename: Scott
authors.initials: S
authors.lastname: Tyldesley
mesh_terms: D001071:Appointments and Schedules; D001955:British Columbia; D003198:Computer Simulation; D015276:Health Care Rationing / Q000458:organization & administration*; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration*; D017064:Process Assessment, Health Care; D013997:Time Factors; D013996:Time and Motion Studies