Using overbooking to manage no-shows in an Italian healthcare center

Abstract

Background: In almost all healthcare systems, no-shows (scheduled appointments missed without any notice from patients) have a negative impact on waiting lists, costs and resource utilization, impairing the quality and quantity of cares that could be provided, as well as the revenues from the corresponding activity. Overbooking is a tool healthcare providers can resort to reduce the impact of no-shows. Methods: We develop an overbooking algorithm, and we assess its effectiveness using two methods: an analysis of the data coming from a practical implementation in an healthcare center; a simulation experiment to check the robustness and the potential of the strategy under different conditions. The data of the study, which includes personal and administrative information of patients, together with their scheduled and attended examinations, was taken from the electronic database of a big outpatient center. The attention was focused on the Magnetic Resonance (MR) ward because it uses expensive equipment, its services need long execution times, and the center has actually used it to implement an overbooking strategy aimed at reducing the impact of no-shows. We propose a statistical model for the patient's show/no-show behavior and we evaluate the ensuing overbooking procedure implemented in the MR ward. Finally, a simulation study investigates the effects of the overbooking strategy under different scenarios. Results: The first contribution is a list of variables to identify the factors performing the best to predict no-shows. We classified the variables in three groups: "Patient's intrinsic factors", "Exogenous factors" and "Factors associated with the examination". The second contribution is a predictive model of no-shows, which is estimated on context-specific data using the variables just discussed. Such a model represents a fundamental ingredient of the overbooking strategy we propose to reduce the negative effects of no-shows. The third contribution is the assessment of that strategy by means of a simulation study under different scenarios in terms of number of resources and no-show rates. The same overbooking strategy was also implemented in practice (giving the opportunity to consider it as a quasi-experiment) to reduce the negative impact caused by non attendance in the MR ward. Both the quasi-experiment and the simulation study demonstrated that the strategy improved the center's productivity and reduced idle time of resources, although it increased slightly the patient's waiting time and the staff's overtime. This represents an evidence that overbooking can be suitable to improve the management of healthcare centers without adversely affecting their costs and the quality of cares offered. Conclusions: We shown that a well designed overbooking procedure can improve the management of medical centers, in terms of a significant increase of revenue, while keeping patient's waiting time and overtime under control. This was demonstrated by the results of a quasi-experiment (practical implementation of the ...

Modeling the No-Show of Patients to Exam Appointments of Computed Tomography

“…indicating that past no-show behavior is carried onto future appointments, as observed in previous studies [3,24]. Likewise, the number of no-shows in consultations in the previous year was found statistically signi cant and positively associated to no-show in previous works [13,15,25].…”

“…This work contributes to the existing literature on no-show modeling in Radiology [3,9,15,21,22,24,[30][31][32][33] in several ways. First, by corroborating ndings on no-show predictors in previous works and compiling such results (see Additional le 4: Table S3).…”

<p>Evaluating the Impact of Patient No-Shows on Service Quality</p>

“…Parente et al managed to reduce the no-show rates significantly using this methodology for overbooking the achieved an average noshow of about 14%. 20 In addition, there was a minor increase in the patients' waiting time. Both Alaeddini et al and Harvey et al developed linear regression models to shed light on no-show phenomenon.…”

Comparação entre a utilização de mensagem curta de texto e ligação telefônica na redução do absenteísmo ambulatorial em Unidade Básica de Saúde de Ribeirão Preto

“…A possibilidade de se faltar a uma consulta pode estar associada a fatores distintos (MESA et al, 2015;PARENTE et al, 2018;KERRISON et al, 2015;HALLSWORTH et al, 2015…”

“…Devido à administração pública não visar lucro na atividade avaliada pelo projeto, a forma de retorno esperado da aplicação dessa ferramenta será a economia de gastos por meio de uma melhor produtividade das unidades. O não comparecimento do paciente ao agendamento ocorre devido a inúmeros motivos, com a maior prevalência do esquecimento, uma estratégia que auxilie como lembrete é de fundamental importância para a diminuição (HALLSWORTH et al, 2015;PARENTE et al, 2018). Para isso, é necessário que seja utilizada uma ferramenta que tenha baixo custo final de implantação e que haja a abrangência de utilização entre o público-alvo da instituição.…”