Overbooking Doc Appointments May Solve No-Show Problem, Research Finds

Posted: June 24, 2013 at 5:00 am, Last Updated: June 25, 2013 at 7:10 am

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By Michele McDonald

Bjorn Berg. Creative Services photo

Bjorn Berg. Creative Services photo

To treat appointment no-shows, doctor’s offices may need to borrow a tactic from airlines, hotels and car rental agencies — overbooking, according to George Mason University research.

Missed appointments eat into already-lean revenue for health care providers, says Bjorn Berg, an assistant professor in Systems Engineering and Operations Research, which is part of the Volgenau School of Engineering. Nearly a quarter of patients may cancel the day of their appointment, he says.

But overbooking may give patients pause, even though it could mean they have an appointment sooner rather than later, Berg says. “Overbooking has a negative connotation because people think of it as the time when they were bumped from a flight,” he says.

Berg is applying methods typically used in manufacturing and service industries to the health care field. He studied outpatient endoscopy suites. Endoscopes are cameras known for their use in such procedures as colonoscopies.

No-shows are common in the endoscopic suites; close to one in five patients didn’t show up. The cost of canceled appointments adds up because expensive equipment is underutilized and the time of doctors, technicians and other personnel is wasted.

“We were really surprised how prevalent the no-show rate was,” Berg says. Doctor’s offices simply need to plan that some patients won’t show up.

Reasons why patients fail to attend their appointments vary from illness that day, procedure anxiety, improved symptoms and simple forgetfulness. And patients are even more likely to forget their appointment if there’s a long lag time, called “indirect waiting,” between when they make the appointment and when it actually happens, Berg points out.

The usual reminders — telephone calls and pre-assessment appointments — cost money and only go so far in mitigating the problem. Still, overbooking presents its own dilemmas. Patients who have to wait too long are understandably dissatisfied. Plus, patients who show up and are prepared for the colonoscopy shouldn’t be forced to wait or reschedule due to overbooking, Berg says.

That’s where computer simulation models can help solve the problem by providing efficient ways to schedule patients, Berg says. Berg and his team studied endoscopy suites at the University of North Carolina School of Medicine and the UNC Health Care System in Chapel Hill, N.C.

A single endoscopy outpatient office has a lot of moving parts: there are four procedure rooms, two gastroenterologists, four intake bays, four recovery bays, one intake nurse, four procedure nurses, two float nurses, one recovery nurse and four endoscopy technicians in the particular suite that was studied. It’s easy to understand why the office doesn’t want its people to have nothing on their hands but time and for equipment to be idle.

While some offices may book two patients for one slot, there are more effective options, Berg says. The key is not only how many patients are scheduled each day but also how they’re spread throughout the day.

Systems engineering methods can be applied to other health care resources, including staffing. Facing intense cost pressures and health care reform, health care professionals are searching for better ways to do their jobs.

“Appointment scheduling is just one area,” Berg says. “The health care world is starting to use analytics and quantitative methods in a way it didn’t before. There’s just so much opportunity for systems engineering to become more involved in health care fields.”

Write to Michele McDonald at mmcdon15@gmu.edu

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