title: Optimizing appointment template and number of staff of an OB/GYN clinic--micro and macro simulation analyses.
abstract: BACKGROUND
  The Department of Obstetrics and Gynecology (OB/GYN) at the University of Arkansas for Medical Sciences (UAMS) tested various, new system-restructuring ideas such as varying number of different types of nurses to reduce patient wait times for its outpatient clinic, often with little or no effect on waiting time. Witnessing little progress despite these time-intensive interventions, we sought an alternative way to intervene the clinic without affecting the normal clinic operations.
  
  
  OBJECTIVE
  The aim is to identify the optimal (1) time duration between appointments and (2) number of nurses to reduce wait time of patients in the clinic.
  
  
  METHODS
  We developed a discrete-event computer simulation model for the OB/GYN clinic. By using the patient tracker (PT) data, appropriate probability distributions of service times of staff were fitted to model different variability in staff service times. These distributions were used to fine-tune the simulation model. We then validated the model by comparing the simulated wait times with the actual wait times calculated from the PT data. The validated model was then used to carry out "what-if" analyses.
  
  
  RESULTS
  The best scenario yielded 16 min between morning appointments, 19 min between afternoon appointments, and addition of one medical assistant. Besides removing all peak wait times and bottlenecks around noon and late in the afternoon, the best scenario yielded 39.84 % (p<.001), 30.31 % (p<.001), and 15.12 % (p<.001) improvement in patients' average wait times for providers in the exam rooms, average total wait time at various locations and average total spent time in the clinic, respectively. This is achieved without any compromise in the utilization of the staff and in serving all patients by 5 pm.
  
  
  CONCLUSIONS
  A discrete-event simulation model is developed, validated, and used to carry out "what-if" scenarios to identify the optimal time between appointments and number of nurses. Using the model, we achieved a significant improvement in wait time of patients in the clinic, which the clinic management initially had difficulty achieving through manual interventions. The model provides a tool for the clinic management to test new ideas to improve the performance of other UAMS OB/GYN clinics.
authors.affiliation: Department of Mathematics, University of Central Arkansas, 201 Donaghey Avenue, Conway, 72035, Arkansas, USA. rblenin@uca.edu.
authors.forename: R B
authors.initials: RB
authors.lastname: Lenin
authors.affiliation: Department of OB/GYN, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, 72205, Arkansas, USA. LoweryCurtisL@uams.edu.
authors.forename: Curtis L
authors.initials: CL
authors.lastname: Lowery
authors.affiliation: Department of OB/GYN, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, 72205, Arkansas, USA. WCHitt@uams.edu.
authors.forename: Wilbur C
authors.initials: WC
authors.lastname: Hitt
authors.affiliation: Department of OB/GYN, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, 72205, Arkansas, USA. NAManning@uams.edu.
authors.forename: Nirvana A
authors.initials: NA
authors.lastname: Manning
authors.affiliation: College of Medicine, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, 72205, Arkansas, USA. lowerypeterb@uams.edu.
authors.forename: Peter
authors.initials: P
authors.lastname: Lowery
authors.affiliation: Department of OB/GYN, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, 72205, Arkansas, USA. EswaranHari@uams.edu.
authors.forename: Hari
authors.initials: H
authors.lastname: Eswaran
mesh_terms: D000554:Ambulatory Care Facilities; D001071:Appointments and Schedules; D003198:Computer Simulation; D005260:Female; D006176:Gynecology; D006801:Humans; D017146:Models, Organizational; D009774:Obstetrics; D000066908:Simulation Training; D000078329:Workforce