Outpatient appointment scheduling in presence of seasonal walk-ins

This study investigates appointment systems (AS), as combinations of access rules and appointment-scheduling rules, explicitly designed for dealing with walk-in seasonality. In terms of ‘access rules’, strategies are tested for adjusting capacity through intra-week, or monthly seasonality of walk-ins, or their combined effects. In terms of ‘appointment rules’, strategies are tested to determine which particular slots to double-book or leave open in cases where seasonal walk-in rates exceed or fall short of the overall yearly rate. In that regard, this study integrates capacity and appointment decisions, which are usually addressed in an isolated manner in previous studies. Simulation optimization is used to derive heuristic solutions to the appointment-scheduling problem, and the findings are compared in terms of in-clinic measures of patient wait time, physician idle time and overtime. The goal is to provide practical guidelines for healthcare practitioners on how to best design their AS when seasonal walk-ins exist.