Objective: To investigate the effectiveness, from a system\'s perspective, of offering group counseling options in college counseling centers. Methods: We achieve this through a data-driven simulation-based approach with the aim of providing administrators with a quantitative tool that informs their decision-making process. Results: Our simulation experiments reveal that offering group counseling options without resource reallocation does not have the desired positive impact on the system\'s performance. However, with resource reallocation, our results demonstrate that the introduction of group counseling options can significantly improve the performance of the system by as much as 40%. Conclusions: Group counseling options, coupled with proper resource reallocation strategies, are effective in reducing access time of first-time patients by as much as 40%. The effect of group counseling is highly dependent on both the number of offered groups as well as their scheduling policy. Scheduling policies have to be scrutinized in light of their resulting group waiting time and resource-utilization efficiency.

To assess the demographic and geographic variations in access time - defined as years between the date of symptom onset and initial date of neurological care - in pediatric patients presenting with staring spells.
We conducted a secondary analysis of a retrospective chart review study from 2011 to 2021. A total of 1,353 staring spell patients, aged 0 to 17.9 years, were analyzed for age, sex, race/ethnicity, insurance, county, average county annual per capita personal income, and access time.
Patients aged 0-2.9 years had the shortest median access time of 0.3 years, compared to 1.2 years in patients aged 3-12.9 years and 1.0 year in patients aged 13-17.9 years. Statistically significant differences were seen based on race/ethnicity and insurance with White patients having shorter access time of 0.5 years compared to Black patients with 1.0 year and self-pay patients having the shortest access time of 0.4 years compared to patients with private insurance (0.7 years). Warren County had the largest annual per capita personal income of $65,855 and access time of 0.5 years compared to Preble county with the least annual per capita personal income of $45,016 and access time of 1.1 years.
Demographic parameters of age, race/ethnicity, insurance, and annual county per capita personal income appeared to be associated with access time to initial neurological care in patients with staring spells. These associations need to be investigated further to ensure timely access to neurological care and to ensure equity in health care.

Waiting time in healthcare is a significant problem that occurs across the world and often has catastrophic effects. There are various terms used for waiting time (\"sojourn\", \"throughput\" etc.) and there is no consensus on how these terms are defined. Ambiguous definitions of waiting time make it difficult to compare and measure the problems related to waiting times and delays in healthcare. We present a systematic search and review of the Operations Research and Management Science (ORMS) literature on delays in healthcare services. We search for articles from 2004 to 2019 and base our search strategy on a well-known healthcare planning and control decision taxonomy. An important step towards reducing the ambiguity in the definitions is to distinguish between access time and waiting time. We provide clear definitions and examples of access time and waiting time, and we classify our search results according to three categories: article type, healthcare service investigated and ORMS technique used to solve the delay problem. We find that half of the ORMS research on the waiting and access time problem is done on Ambulatory Care services. We provide tables for each healthcare service that highlight key definitions, the techniques that are used most often and the healthcare environment where the research is done. This research highlights the significant ORMS research that is done on access and waiting time in healthcare as well as the remaining research opportunities. Moreover, it provides a common language for the ORMS community to solve critical waiting time issues in healthcare.

BACKGROUND: Hospitals face the challenge of managing demand for limited computed tomography (CT) resources from multiple patient types while ensuring timely access.
METHODS: A discrete event simulation model was created to evaluate CT access time for emergency department (ED) patients at a large academic medical center with six unique CT machines that serve unscheduled emergency, semi-scheduled inpatient, and scheduled outpatient demand. Three operational interventions were tested: adding additional patient transporters, using an alternative creatinine lab, and adding a registered nurse dedicated to monitoring CT patients in the ED.
RESULTS: All interventions improved access times. Adding one or two transporters improved ED access times by up to 9.8 minutes (Mann-Whitney (MW) CI: [-11.0,-8.7]) and 10.3 minutes (MW CI [-11.5, -9.2]). The alternative creatinine and RN interventions provided 3-minute (MW CI: [-4.0, -2.0]) and 8.5-minute (MW CI: [-9.7, -8.3]) improvements.
CONCLUSIONS: Adding one transporter provided the greatest combination of reduced delay and ability to implement. The projected simulation improvements have been realized in practice.

Experiments were performed to determine the effects of feeding method and hay processing (Experiment 1), energy supplement moisture content and feeding method (Experiment 2), and access time to hay (Experiment 3) on cow body weight (BW), dry matter intake (DMI), and hay or energy supplement intake and waste. Experiment 1 was designed as a 4 × 4 Latin Square using 48 multiparous, late-gestating, Angus cows (626 kg initial BW). Cows were stratified by age and BW into four treatment groups (n = 12 cows/group); treatment groups were then initially assigned randomly to treatments in a sequence of preset Latin Square periods. In Experiment 1, round bales were processed and delivered on the pen surface or in a bunk, or left unprocessed and delivered in a hay ring or rolled out on the pen surface. Experiment 2 was designed as a 6 × 6 Latin Square utilizing 54 multiparous, late-gestating, Angus cows (616 kg initial BW). Cows were stratified by age and BW into treatment groups (n = 9 cows/group); treatment groups were then initially assigned randomly to treatments in a sequence of preset Latin Square periods. In Experiment 2, corn screenings (CS) or wet beet pulp (BP) were fed in a structure (inverted tire or bunk) or BP only on the pen surface. Experiment 3 was designed as a replicated 3 × 3 Latin Square utilizing 24 multiparous, late-gestating, Angus cows (584 kg initial BW). Cows were stratified by age and BW into treatment groups (n = 8 cows/group); treatment groups were then initially assigned randomly to treatments in a sequence of preset Latin Square periods. In Experiment 3, cows were permitted access to round-bales in a hay ring for 6, 14, or 24 h. In Experiment 1, hay DMI was not affected (P ≥ 0.579). Hay waste was greater (P ≤ 0.007) when hay, processed or not, was fed on the pen surface. In Experiment 2, hay DMI was greatest (P ≤ 0.011) for cows fed no supplement and those fed CS in a bunk. Feeding BP in a bunk led to the greatest (P ≤ 0.003) hay waste. In Experiment 3, cows permitted 6-h access consumed and wasted less (P < 0.001) hay compared with those permitted longer access; BW was unaffected (P ≥ 0.870). In these experiments, cows fed hay on the pen surface, processed or not, achieved similar DMI as those fed in a ring or bunk, but wasted more hay. Delivering BP in a bunk or on the pen surface increased hay and supplement waste, respectively. Controlling access to hay reduced DMI and waste while maintaining cow BW.

Tactical capacity planning is a key element of planning and control decisions in healthcare settings, focusing on the medium-term allocation of a clinic\'s resources to appointments of different types. One of the most scarce resources in healthcare is physician time. Due to uncertainty in demand for appointments, it is difficult to provide an exact match between the planned physician availability and appointment requests. Our study uses cardinality-constrained robust optimization to develop tactical capacity plans which are robust against uncertainty, providing a feasible allocation of capacity for all realizations of demand to the extent allowed by the budget of uncertainty. The outpatient setting we consider sees first-visit patients and re-visit patients, and both patient types have access time targets. We experimentally evaluate our robust model and its practical implications under different levels of conservatism. We show that we can guarantee 100% feasibility of the robust tactical capacity plan while not being fully conservative, which will lead to the clinic saving money while being able to meet demand despite uncertainty. We also show how the robust model helps us to identify the critical time periods leading to worst case physician peak load, which could be valuable to decision-makers. Throughout the experiments, we find that the step of translating available data into an uncertainty set can influence the true conservatism of a solution.

OBJECTIVE: Long access time to computed tomography (CT) facilities is seen as a substantial problem in many hospitals. Walk-in is an intervention that eliminates access times, since it gives patients direct access without an appointment. The Rijnstate hospital implemented walk-in CT in 2010, which offered the opportunity to study the positive and negative effects of walk-in CT in practice and how these effects are balanced.
METHODS: Employee interviews (N = 10), patient surveys (N = 535) and a data analysis using data from the Electronic Patient Record (EPR) of 129.148 patients between October 2008 and March 2017 were conducted.
RESULTS: All stakeholders stated that the system improved with the introduction of walk-in. The interviews also resulted in main performance indicators: access time, waiting time, one-stop-shop, autonomy of choice, productivity and employee satisfaction. The patient survey divulged the maximum acceptable waiting time: 79% of patients stated this to be 15-30 minutes or more. When asked which performance indicator is most important, \'one stop shop\' was mentioned by 134 patients over access time, waiting time and autonomy of choice (ranged from 79 to 88). The data analysis showed a doubling in production, while CT capacity hardly increased. The percentage of outpatients that had to wait 30 minutes or less has decreased from 85.2% in 2009 to 59.5% in 2016, but the absolute number of outpatients with these waiting times increased from 5.146 to 7.681. Overtime production regarding outpatients has decreased over the years.
CONCLUSIONS: Walk-in CT performs better regarding the main performance indicators than a full appointment system. The reasons are that it almost nullifies CT access time and enhances one-stop-shop for patients. Walk-in also improves satisfaction of patients, referring physicians as well as the entire radiology staff, technicians and doctors alike. Furthermore, all results suggest that productivity can be higher with walk-in than with only appointments.

While theoretical frameworks for optimization of the outpatient processes are abundant, practical step-by-step analyses to give leads for improvement, to forecast capacity, and to support decision making are sparse.
This article demonstrates how to evaluate and optimize the triad of demand, (future) capacity, and access time of the outpatient clinic using a structured six-step method.
All individual logistical patient data of an orthopaedic outpatient clinic of one complete year were analysed using a 6-step method to evaluate demand, supply, and access time. Trends in the data were retrospectively analysed and evaluated for potential improvements. A model for decision making was tested. Both the analysis of the method and actual results were considered as main outcomes.
More than 25 000 appointments were analysed. The 6-step method showed to be sufficient to result in valuable insights and leads for improvement. While the overall match between demand and capacity was considered adequate, the variability in capacity was much higher than in demand, thereby leading to delays in access time. Holidays and subsequent weeks showed to be of great influence for demand, capacity, and access time. Using the six-step method, several unfavourable characteristics of the outpatient clinic were revealed and a better match between demand, supply, and access time could have been reached with only minor adjustments. Last, a clinic specific prediction and decision model for demand and capacity was made using the 6-step method.
The 6-step analysis can successfully be applied to redesign and improve the outpatient health care process. The results of the analysis showed that national holidays and variability in demand and capacity have a big influence on the outpatient clinic. Using the 6-step method, practical improvements in outpatient logistics were easily found and leads for future decision making were contrived.

Purpose Carotid artery anatomy is thought to influence internal carotid artery access time (ICA-AT) in patients requiring mechanical thrombectomy for acute ischemic stroke. This study investigates the association between ICA-AT and carotid anatomy. Material and methods Computed tomography angiography (CTA) data of 76 consecutive patients presenting with acute ischemic stroke requiring mechanical thrombectomy for middle cerebral artery or carotid T occlusion were evaluated. The supraaortic extracranial vasculature was analyzed regarding take-off angles and curvature of the affected side. Digital subtraction angiography data were primarily analyzed regarding ICA-AT and secondarily regarding recanalization time and radiographic result. Results ICA-AT was significantly influenced by vessel tortuosity. Take-off angle of the left common carotid artery ( p = 0.001) and the brachiocephalic trunk ( p = 0.002) as well as the tortuosity of the common carotid artery ( p = 0.002) had highest impact on ICA-AT. For recanalization time, however, we found only the take-off angle of the left common carotid artery to be of significance ( p = 0.020). There was a tendency for ICA-AT to correlate with successful (mTICI ≥ 2 b) revascularization (average time of successful results was 24.3 minutes, of unsuccessful was 35.6 minutes; p = 0.065). Every evaluated segment with less carotid tortuosity showed a carotid AT below 25 minutes. Conclusion Supraaortic vessel tortuosity significantly influences ICA-AT in mechanical thrombectomy for an acute large vessel. There furthermore was a trend for lower successful recanalization rates with increasing ICA-AT.