A simulation study of patient flow in Mohs Micrographic Surgery clinics

Mohs Micrographic Surgery (MMS) is a surgical method used for the excision of aggressive skin cancers in areas of high cosmetic importance, such as the face and hands. The practice has been gaining popularity worldwide for its low recurrence rates and cosmetic results. Current clinics though are plagued by extreme wait times and an overall poor patient experience. In this paper we look to explore this problem by applying systems engineering principles including optimization and scheduling with the goal of improving the patient experience. Currently, little literature exists exploring the difficulties associated with scheduling for MMS clinic which primarily revolves around patient recirculation for an unknown number of repetitions with little predictive ability. By using simulation models in conjunction with heuristic building, we have explored the current practice of clinics through several important performance measures while being able to determine an optimal number of patients to be scheduled. We have also explored the impact of changing re-entrant probability on the nature of the patient schedules. We have developed heuristics and tested them in a range of cases. Despite less poor results, many valuable lessons have been learned about MMS patient flow.

A simulation study of patient flow in Mohs Micrographic Surgery clinics Conference Paper