Sebastian Rios 1102 ENC Professor Wolcott 10/21/2013 Annotated Bibliography: How Engineers aid Appointment scheduling in the

Medical Field For my Annotated Bibliography, I researched the discourse community of Industrial Engineering and found the topic improving appointment scheduling in Hospitals. The argument that is being made, by the authors of the articles that I chose, is that there is a problem with current process in hospitals that deal with the physical flow of patients through the hospital and in the scheduling software that the hospitals uses. Every articles purpose is to propose an improvement on an individual hospitals appointment scheduling process, to make it more efficient and cheaper, than it was. Thus, Industrial engineers are helping the medical field because they make hospitals schedule patients more efficiently, which save the hospitals money by presenting, as well as, apply technological innovations and structural innovations. This Annotated Bibliography will show how Engineers aid and advance the process of appointment scheduling through all hospitals by making them more efficient with technological innovations and new processes. The majority of the articles compose of Industrial Engineers providing an alternative, more efficient, and less cost effective, to aid the hospitals in improving their current way of appointment scheduling. The articles include graphs, equations, and formulas, inventions that prove that the authors of the articles proposition will work and make the flow of people both physical and in the system run more smoothly. The time frame of the articles is from the late 1990s to 2013, this is proof that the problem of Hospitals having inefficient appointment scheduling a patient flow have been existing for a relatively long time.

There is a need to include some of the important advances that engineers have made in the field of medical appointment scheduling and patient flow. So, anyone who may be interested in advancements in this field, like medical students, hospitals across American and clinics, may find this useful to apply it to their practice. Also, inspiring or established engineers might find these finding interesting and decide to pursue work in this field and further the advancements. Gupta, Diwakar and Brian Denton Appointment scheduling in health care: Challenges and opportunities. IIE Transaction (2008) 40, p.800-19. ISSN: 0740-817X print. Oct 2008. Web. This article was written by members of the Graduate Program in Industrial & Systems Engineering, and the Department of Mechanical Engineering, from the University of Minnesota and the North Carolina State University. Which are accredited and prestigious schools of upper education. The article is about analyzing Appointment scheduling in hospitals or Clinics waiting room. First, the authors states all the processes and the individual factors that make up the hospitals data base and the physical flow of patients (both scheduled and non-scheduled) that go through the hospital in a studied time. Even though, the authors results varied between the different processes (and factors), such as scheduling elective surgery appointments, mapped out arrival times, patient and providers preferences, the authors found, at least marginal, way to make the process and factors that make up appointment scheduling more efficient. Lau, Hon-Shiong and Amy Hing-Ling Lau. A fast procedure for computing the total systemcost of an appointment schedule for medical and kindred facilities. IIE Transactions (2000) 32, 833-839. Print. Oct, 2013. Web. This article was composed by the members of the department of Applied Statistics and Management Science of the University of Hong Kong and the Department of Accounting, Hong Kong Polytechnic University. The article

Deals with presenting a hypothetical scenario that deals with the conflict between the users, who are the patients, and the facility, which is the Hospital they did the experiment with. The hypothetical situation maps out how to arrange the ultimate time objective in the scenario to improve the appointment time of each of the patients to be treated on a given day. This will minimize the total expected daily cost. Through different formulas and graphs, the authors were able to present a procedure that rapidly determines the idle cost, which is the cost per patient that hospitals spends because of the time the patient is unattended, and the expected facility idle cost, which is the cost of the entire day that the hospitals has. The authors found a way to reduce both. Kong, Qingxia and Chun-Yee Lee, Chung Praw Teo, Zchihao Zheng. Schedule Arrivals to a Stochastic Service Delivery System Using Copositive Cones. The authors of this article are from the school of Business in the University of Adolfo Ibokez, Department of Industrial Engineering and Logistics Management, Hong Kong University of Science & Technology and the Department of Decision Sciences in the University of Singapore. This article investigates appointment-scheduling problem in an outpatient clinic with a single doctor. The authors examine the number of patients and their sequence. Also, they analyze how the Hospital is affected by the specific appointment time for each patient. The look for distributional robust schedule that minimize the expectation of the weighted sum of patients waiting time and the doctors overtime. They then, present a model that will handle additional support constraints of the service donations. Using primal-dual optimality conditions. They developed on efficient semi-definite relaxation of the comic program and apply that approach to improve the efficiency of the appointment system of the clinic.

Wang, Xia Yo and Alexander Wong Multi-Parametice Clustering for Sensor Node Coordiation in Cognitive Wireless Sensor Networks. The authors in are a part of the department of the Systems Design Engineering of the University of Waterloo in Canada. Cluster scheme is optimizing an objective function defined on the partitions of the underlying set of a finite metric space. In this paper, we construct a framework for studying what happens when we instead impose various structural conditions on the clustering schemes, under the general heading of functoriality. This article is about how the authors peruse the development of wireless sensor network for the Health Care applications have been motivated and driven by the increasing demand of the real-time monitoring of patients in the hospital. The authors faced the challenge of developing such sensors network is he need for coordinating a large number of randomly deployed sensor nodes. Sensor Node is a wireless sensor network that is capable of performing some processing, gathering sensory information and communicating with other connected nodes in the network. Through their methods of research they divided the four parts that go into the proposed multi-parametric clustering scheme. The extensive performance evaluation that is conducted is to study the impact of important factors to show that the proposed clustering scheme can be on excellent candidate for use in large scale wireless sensor network with high dynamics. In turn making the monitoring of real-time patients in the Hospitals, more efficient. Ozen, Asli and Hari Balasubramanian. The impact of case mix on timely access to appointments in a primary care group practice. 13 September 2012 / Published online: 18 October 2012 Springer Science and Business Media New York 2012. Health Care Manag Sci (2013) 16:101118. Web. The article itself was published by Health Care

Management Science Journal, which is a well-known journal in the medical field. The article includes a physicians appointment burden is determined by the size and composition of the panel. The panel is Size refers to the number of patients in the panel while composition refers to the case-mix, or the type of patients (older versus younger, healthy versus chronic patients), in the panel. A panel refers to the set of patients for whose long term, holistic care the physician is responsible. The authors quantify the impact of the size and case-mix on the ability of a multi-provider practice to provide access to its appointed patients. The authors use overflow frequency, or the probability that the demand exceeds the capacity, as a measure of access. This optimization framework helps a practice of quantifying the imbalances across physicians due to the variation in case mix and panel size, and the resulting effect on access; and determine how panels can be altered in the least disruptive way to improve access. The authors determine their methodology using four test practices created using patient level data from the primary care practice at Mayo Clinic, Rochester, Minnesota. The authors then analyze the appointments that where scheduled before, then they focus on classifying the patients whether its gender, race, sex and age. Then the authors give examples of the impact of case-mix using a single simulation, then present a design for the panel and redesigns. Qu, Xiuli and Ronald L. Rardin, Julie Ann S. Williams Single versus hybrid time horizons for open access scheduling. Computers & Industrial Engineering Volume 60, Issue 1, February 2011, Pages 5665. Web. The authors are from the departments of North Carolina Agricultural and Technical State University and the Department of Industrial and Systems Engineering. Also, University of Arkansas, Department of Industrial

Engineering, and University of West Florida and Department of Management. The difficulty of scheduling short-notice appointments due to schedules booked with routine check-ups are prevalent in outpatient clinics, especially, in primary care clinics, which lead to more patient no-shows, lower patient satisfaction, and higher healthcare costs. This was first introduces in the 1990s. Open access scheduling is just-in-time concept that seeks to schedule both short-notice and routine appointments. While open access scheduling can be applied to services such as accounting, financial planning, real estate, law, and healthcare, this paper was motivated by primary care clinics seeking to schedule their provider capacity more effectively. The authors understood that open access scheduling was introduced to overcome these problems by reserving enough appointment slots for short-notice scheduling. The appointments scheduled in the slots, reserved for short-notice are called open appointments. Open access scheduling policy has a single time horizon for open appointments. Then, the authors describe a typical open access scheduling policy reported in the literature, and then propose a hybrid open access policy. After that, the authors discuss two performance measures to compare open access scheduling policies. Finally, the authors present the analytical and numerical results of the comparison between the two policies. Chakraborty, Santanu and Kumar Muthuraman, Mark Lawley. Sequential clinical scheduling with patient no-shows and general service time distributions. IIE ISSN: 0740-817X print / 1545-8830. Web. The authors of this article are from the departments of the school of Industrial Engineering from Purdue University, the school of Business in the University of Texas and the Weldon school of Biomedical Engineering at Purdue University. The article was about how the authors presented a situation where, patients call a medical

clinic to request an appointment with their physician and during the call, the scheduler assigns the patient to an available slot in the physicians schedule. This is communicated to the patient before the call terminates and, thus, the schedule is constructed sequentially. In practice, there is very limited opportunity to adjust the schedule once the complete set of patients is known. Scheduled patients might not attend, that is, they might no-show, and the service times of those attending are random. Patient no-show is one of the most common and frustrating problems in clinic operations. No-shows patients, introduce signicant uncertainty into clinical operations and limit accessibility to other patients by reserving appointment slots that go unused. That is why the authors developed a myopic scheduling algorithm with an optimal stopping criteria for this problem assuming exponential service times already exists in the literature. This article presents our model formulation, and provides concluding this assumption and develops numerical techniques for general service time distributions. The scheduling algorithm and the derivation of various expressions that are necessary for the scheduling algorithm. The methodology of the authors is first, explaining the development of the special case of gamma service times, and then, provides the theoretical guarantees that establish the unimodality of the objective evolution. Later, the authors present the experimental results and discussion. Finally, the authors discusses future research. Devi, Prasanna and Suryaprakasa Rao, Sai Sangeetha. Prediction of Surgery Times and Scheduling of Operation Theaters in Ophtholmology Department. Springer Science and Business Media, LLC 2010. J Med Syst (2012) 36:415430. Web. The authors are practicing Ophthalmologists that are relevant in the field. Also, the Science and Business Media journal is a prestigious source for reliable articles. Starts of by setting the

framework for forecasting the surgery time by taking into account the surgical environment in an ophthalmology department. The estimation of surgery times is done using three techniques, such as the Adaptive Neuro Fuzzy Inference Systems (ANFIS), Artificial Neural Networks (ANN) and Multiple Linear Regression Analysis (MLRA) and the results of estimation accuracy were compared. With that in mind the authors go to state that Surgeons as well as administrators have a responsibility to ensure that theatre (one of the most expensive departments in the hospital and it is here the surgeries are performed) facilities are used as fully as possible and also that good use is made of the operating time in the theatre so that the dividend from the investments on the operation theatre is maximized. Considering the problem of forecasting the surgical time in some detail, the authors observe that the surgery time depends on factors like the patient profile, type of anesthesia used, experience of the anesthesiologist, surgeon and supporting staff. The ANFIS model is found to out-perform the other two models. The scheduling is done using P-Cmax algorithm. Encouraging results have been obtained for optimal scheduling of Operation Theater, in simulations. The same has to be verified in real life scenario in a hospital. Ogulata, Noyan and Melik Koyuncu, Esra Karakas. Personnel and Patient Scheduling in the High Demanded Hospital Services: A Case Study in the Physiotherapy Service. Springer Science and Business Media. LLC 2008. J Med Syst (2008) 32:221228. Web. The authors are a part of Department of Industrial Engineering, Faculty of Engineering and Architecture of Cukurova University. The article because of the high demand but limited staffs within some services of a hospital, that require a proper scheduling of staff and patients. In this study, a hierarchical mathematical model is proposed to generate weekly

staff scheduling. Due to computational difficulty of this scheduling problem, the entire model is broken down into manageable three hierarchical stages, selection of patients, and assignment of patients to the staff, scheduling of patients throughout a day. The authors stated that improving these conditions can lead to an increase in the success of treatment process. In addition to this, the authors included that efficient utilization of manpower has always been a key concern in any organization and one of the most important means to achieve productivity gain. The authors concluded that this focus on real world problems in physiotherapy services and to suggest a scheduling approach that can be understood easily; also, a hierarchical mathematical model proposed in this study enables us to obtain optimum solution in acceptable solution time. However the big problem with this experiment has several limitations, like preferences of patients regarding which day of the week they can come to the treatment were not taken into account in this model. Also, it is almost impossible to make a schedule that satisfies all selected patients preferences of their treatment day. This takes away for the finding of the article. Although, the authors cant take into account these preferences, they manage to decrease the patients waiting time in the hospital via the proposed model and this was the biggest problem for patients. John Corlett, et al. "Performance Metrics for Advanced Access." Journal Of Healthcare Management 51.4 (2006): 246-258. Academic Search Premier. Web. 23 Oct. 2013 the authors are a part of the Departments of industrial and systems engineering and of Mechanical Engineering. Along, with medical departments like care redesign manager, Allina Health Systems, Coon Rapids, Minnesota. The article consisted with addressing how many clinics have implemented, or plan to implement, the advanced access

technique (also called Open Access) for scheduling outpatient appointments. An advanced access system has two primary goals, which are, providing timely access and improving continuity of care. Open access is designed to reduce the time patients must wait for a scheduled appointment, by matching daily appointment supply and demand. Even though, the authors stated there are factors that make it difficult to sustain initial success in achieving supply-demand balance, including different practice styles of doctors, differences in panel compositions and patient preferences, and time-varying demand patterns. The author found that several performance measures that can help clinic directors monitor and evaluate their advanced access implementation. We also discuss strategies for sustaining advanced access in the long run. The authors used the electronic appointment data to calculate each physician's average daily demand for appointments and its variability. Thus, the authors concluded that capacity flexibility strategy needs to be continually updated to accommodate changing requirements with the doctors way of treating patients

Wang, Wen-Ya, Diwakar Gupta, and Sandra Potthoff. "On Evaluating The Impact Of Flexibility Enhancing Strategies On The Performance Of Nurse Schedules." Health Policy 93.2/3 (2009): 188-200. Business Source Premier. Web. 23 Oct. 2013. The authors are apart of Industrial & Systems Engineering Program in the University of Minnesota and School of Public Health, Division of Health Policy & Research, University of Minnesota. The article was about how large hospitals are organized into a variety of specialized nursing units. For example, telemetry units house patients under observation or those awaiting a surgical procedure, medical/surgical units house patients who are either recovering after a surgery or have a medical need requiring hospitalization, maternity units house new

mothers or babies. So, most nurses are assigned to specific units, although there are some that belong to a float pool and they serve in different units depending on the needs. In some situations, nurses that are not in the float pool can be assigned to another unit on, if the staffing level is higher than the nursing needs in their home unit and lower in another unit. The authors state that hospitals develop nurse schedules that cover a period of 46 weeks, and are posted several weeks in advance. Once posted, changes to the schedule require voluntary participation by the nurses, making it difficult for hospitals to respond to changes in nursing needs and availability of nurses. Since the methodologies to evaluate such strategies, before testing them in expensive pilot implementation, do not exist. The authors demonstrate how such evaluations can be carried out using historical data. The authors demonstrate the use of our approach by evaluating the benefits of a strategy where nurses are divided into two cohorts and schedules are phase shifted for the two cohorts. The find that staggering schedules allows nursing unit managers to benefit from more frequent updating of needs assessments without having to change work rules. Upon applying our approach to data from a large urban hospital, we discovered that in this example staggering did not improve the performance of nurse schedules.

James R. Wilson, et al. "Modeling Patient Arrivals In Community Clinics." Omega 36.1 (2008): 33-43. Business Source Premier. Web. 23 Oct. 2013. The authors are a part of 1School of Industrial and Systems Engineering, Georgia Institute of Technology, Department of Pediatrics, University of California, and Edward O. Fitts Department of Industrial Engineering, North Carolina State University. Because of tightening resources and rising competition, healthcare facilities face increasing pressure to have patients seen faster and to exit clinic services more quickly. Improved patient flow needs to be balanced with

ensuring adequate time to complete needed clinical functions. Identifying those factors that contribute to unnecessary nonclinical patient wait times would seem a wise undertaking. The authors developed improving methods for modeling and simulating the streams of patients arriving at a community clinic. In previous practice, random patient arrivals were often assumed to follow an ordinary Poisson process; and for scheduled arrivals, each patient's tardiness (i.e., the deviation from the scheduled appointment time) was often assumed to be randomly sampled from a normal distribution. The authors review a nonparametric approach to estimating the associated mean-value function; and we describe an algorithm for generating random patient arrivals from the estimated model. The adequacy of this model of random patient arrivals can be assessed by standard goodness-of-fit tests. These findings are important since testable scheduling optimization strategies must be based upon accurate models for both random and scheduled patient arrivals. The impacts on modeling, as well as implications for practice management, are discussed. The study was conducted by a total of 225 patient observations were obtained during two different time periods (91 observations in the fall of 1999 and 134 in the late summer of 2000) as part of a larger workflow data collection effort. These observations were collected using a workflow data acquisition tool. The authors concluded that the patients should schedule the appointment and a random date and the patient scheduling model should be considerate of the other appointments.

Deanna R. Willis, et al. "Matching Daily Healthcare Provider Capacity To Demand In Advanced Access Scheduling Systems." European Journal Of Operational Research 183.2 (2007): 812-826. Business Source Premier. Web. 23 Oct. 2013. The authors are from the prestigious institutions of Purdue University, School of Industrial Engineering,

University of West Florida, Department of Management and MIS, Indiana University, Department of Family Medicine, 1110 W Michigan Street, Indianapolis, IN 46202, United States. The article is about how, currently, inefficiency of healthcare delivery and barrier to access healthcare are two critical problems faced by most outpatient clinics in the United States. The traditional appointment scheduling systems currently used in outpatient clinics are one of the main causes for the two problems. At the end of a patients current visit, the traditional appointment scheduling systems schedule his/her next visit months in advance. If patients call for a non-urgent visit, they have to wait from several weeks to several months for their visits. The long wait for visits damages timely care. The author went on to state, if emergency care is used when patients cannot be seen by their own physicians in time, continuity of care is broken. Loss of timely care or continuity of care undermines healthcare quality. In addition, the long waiting list for appointments causes more missed appointments, which reduce the efficiency of clinical operations. This article investigates the sensitivity of the optimal percentage of appointments held open for a provider in a clinic session to provider capacity, the noshow rates of prescheduled and open-access appointments, and the distribution of demands for prescheduled and open-access appointments. The authors results illustrate that in the clinic sessions in which the average demand for open-access appointments is much higher than the capacity of a provider, all appointments with the provider should be held open if no appointments have to be prescheduled due to clinical necessity.

Y.H. Shi, et al. "Improving Scheduling Of Emergency Physicians Using Data Mining Analysis." Expert Systems With Applications 36.2 (2009): 3378-3387. Academic Search Premier. Web. 24 Oct. 2013. The authors are a part of the Department of Industrial Engineering,

Chung-Yuan Christian University, Department of Industrial Engineering and Management, National Chin-Yi University of Technology, Office of Medical Information Management, National Taiwan University Hospital, No. 7. This article deals with Emergency departments and how they are the first line in hospitals to face emergency patients. As a major function of emergency medicine, when a patient comes to the emergency department, the emergency medical personnel will first perform a triage procedure and then transfer the patient to associated departments for treatment. In this study, the authors used data mining, classification and a decision tree to analyze the prediction model of patients demand in the Emergency department from real treatment situations. A decision tree is decision support tool that uses a tree-like graph or model of decisions and their possible consequences, including chance event outcomes, resource costs, and utility. In this article, the authors hospitals divide outpatients into 6 departments, including internal medicine, surgery, traumatology, pediatrics, obstetrics and gynecology and dental departments. The rule of department assignment does not depend on patient numbers but because of the hospitals policy and the payment system of the National Health Insurance. In this article, the auhtors objective of human resources utilization is that the numbers of physicians should be considered by patients requirement in order to promote the quality of emergency service and arrange proper number of personnel. By using numbers of physicians needed, which is converted from number of patients in the case hospital in 2004, the authors were able to forecast the number of emergency physicians needed in 2005 for the case hospital through data mining decision tree classification. The authors also took realistic conditions into consideration and make appropriate solutions. Besides, they also constructed the forecast

performance evaluation matrix with ideas from Taguchis Loss Function to estimate the cost loss and also use the performance evaluation matrix to control and continuously improve the shift arrangement situation. The authors concluded that through the completion of this study, it cannot only solve the existing problem in this case hospital, but also through the action procedures in this study to introduce in a different medical treatment environment.

Conclusion:

In the profession Industrial Engineering the main objective is to take a process and use mathematical reason to make the given process a more efficient for the better of the institution. Research applying industrial engineering principles to appointment scheduling is central to the Department of Industrial and Systems Engineering in various Universities across the world. Such research in the department dates back to the 1970s, way before the articles I chose to include in my annotated bibliography. The aid the hospitals or clinic, whether big or small, in their struggle for a better was to maneuver patients throughout their waiting rooms and software. Each engineer, made a contribution to each institution that they were working under with the use of their skills as an industrial engineer.