Computationally efficient evaluation of appointment schedules in health care

We consider the problem of evaluating and constructing appointment schedules for patients in a health care facility where a single physician treats patients in a consecutive manner, as is common for general practitioners, clinics and for outpatients in hospitals. Specifically, given a fixed-length session during which a physician sees K patients, each patient has to be given an appointment time during this session in advance. Optimising a schedule with respect to patient waiting times, physician idle times, session overtime, etc. usually requires a heuristic search method involving a huge number of repeated schedule evaluations. Hence, our aim is to obtain accurate predictions at very low computational cost. This is achieved by (1) using Lindley's recursion to allow for explicit expressions and (2) choosing a discrete-time (slotted) setting to make those expressions easy to compute. We assume general, possibly distinct, distributions for the patients' consultation times, which allows to account for multiple treatment types, emergencies and patient no-shows. The moments of waiting and idle times are obtained and the computational complexity of the algorithm is discussed. Additionally, we calculate the schedule's performance in between appointments in order to assist a sequential scheduling strategy. (C) 2014 Elsevier B.V. All rights reserved.