ABSTRACT

Mohs Micrographic Surgery (MMS) is a layer-by-layer, skin-saving surgical method for excising skin cancer. The number of excised layers is stochastic, which creates operational challenges for the clinic. We develop a discrete-event simulation of a MMS surgical clinic to investigate how appointment schedules impact clinic operations. The model simulates the patient flow for a single day with physician, procedure rooms, and histotechnicians as limiting resources. The process times, rate of no-shows, and number of excised layers are stochastic model inputs. The value of the MMS simulation is demonstrated through analysis of five scheduling methods, thirteen schedule templates, and three performance measures: clinic throughput, patient waiting time, and clinic overtime. The results show that the number of patients scheduled changes the ideal spacing between appointments. MMS clinics can benefit from using this simulation model to explore new scheduling templates, especially when reduced patient waiting time and clinic overtime is a priority.

摘要

莫氏显微手术 (MMS) 是一种用于切除皮肤癌的逐层、节省皮肤的手术方法。切除层的数量是随机的，这给诊所带来了操作挑战。我们开发了 MMS 外科诊所的离散事件模拟，以研究预约时间表如何影响诊所运营。该模型以医生、手术室和组织技术人员为限制资源模拟一天的患者流程。处理时间、未出现率和切除层数是随机模型输入。MMS 模拟的价值通过对五种调度方法、十三个调度模板和三个绩效指标的分析来证明：诊所吞吐量、患者等待时间和诊所加班时间。结果表明，安排的患者数量会改变约会之间的理想间隔。MMS 诊所可以受益于使用此模拟模型来探索新的调度模板，特别是当减少患者等待时间和诊所加班是优先事项时。