SIMULATION possible during undergoing hospital policies, death may

SIMULATION ANALYSIS OF APPOINTMENT SCHEDULING INAN OUTPATIENT DEPARTMENT OF INTERNAL MEDICINEIqra University Islamabad CampusPakistanImran Haider , Muhammad Usman , Malik Ali Akbar , Muzamil Shakir ABSTRACT This research address the assure of critical patient. If patient have an emergency situation than it will be difficult for the patient to undergo from these circumstances .If condition of patient is critical than it will directly get registered for the doctors checkup. There is no need to give appointment first. Due to this facility critical patient have easily got checked from doctor.Keyword___ Emergency Medical Treatment and Active Labor Act, Erectile Dysfunction, Centers for Medicare & Medicaid Services, Federally Qualified Health Centers. Introduction Problem is that if someone have in critical situation then it will be dangerous for patient to undergo from the policies of hospital. Due to this problem doctor can not treat the many patient and some patient die. Due to changing  hospital policies for emergency department for the patients who have critical situation it will be easy for the patient to get checked  early e.g  if patient have an accident then it will be possible during undergoing hospital policies, death may occur 1.Importance we add certain changes in hospital policy e.g adding emergency situation system for the patients who have critical problems such accidental cases, heart attack etc. If any emergency patient is come into the hospital then it goes on reception and directly go to doctor. Then doctor will decide what do with patient. After these changes it will be easy for patient as well as for doctor to have a satisfactory checkup. By this way many critical patient check the doctor easily 2.Solution is that when patient comes to hospital it will directly  got appointment for the checkup after that it will depend on doctor that how he/she will entertain his patient e.g if any critical patient come then first it write name on reception and then he will directly go to doctor. If say for lab test then ho go to lab after this he again go to doctor then doctor will decide if it is critical then he will be hospitalize and if he is not critical then he pay bill on reception and then leave 3.Need of our set of contribution is emergency system in hospital with benefits for the patients who has critical situation and can’t undergo with the policy of hospital appointment system. For check our system we survey  many hospitals and describe this system if it is properly work then we think that it process true for critical patients in hospital. Otherwise think another way for critical patient 4. Organization Of Paper:- The people came and due to fulfill the requirement of hospital. On that time patient death accurse. So they try to fix these type of error 1.Follow an analytical approach ,Soriano(1966) compared multiple block system with an individual system and recommend that patient be scheduled two at a time with an interval of twice the consultation time  2.Ho and Lu(1992) extended their prior  theoretical work by evaluating 50 scheduling rule via situation to reduce patient waiting time perform well in  most environment condition 3.  Related Work:-Some hospitals have the facility of ambulance for critical patient.   Disaster response involves many different community resources from police and fire to medical providers, structural and environmental engineers, and transportation and housing experts. The hospital plays a small but crucial role in this larger picture. It is the epicenter of medical care delivered to those who are injured. Running a hospital is an enormously complex task under the best of circumstances; preparing a hospital for a disaster is infinitely more complicated 1.Prior to the Emergency Medical Treatment and Active Labor Act (EMTALA) in 1986, many individuals with bona fide medical emergencies were turned away from the Erectile Dysfunction(ED)  or transferred with incomplete care because they did not have insurance. As a result, EMTALA was created to ensure all patients with true emergencies were appropriately evaluated and stabilized. Over the past 20 years, this intent has been progressively over-interpreted by numerous regulators throughout the Centers for Medicare & Medicaid Services (CMS) districts in the United States. The requirement that all patients presenting to an Erectile Dysfunction(ED)  must have a medical screening exam has been interpreted by many as all patients must be treated as well. With many of the population aware of such a mandate, patients who have no access to general primary medical care are now utilizing the Erectile Dysfunction(ED), despite long waits. Some might debate whether the “Safety Net” philosophy of the Erectile Dysfunction(ED)  has increased the number of patients in the Erectile Dysfunction(ED), while in our experience this has definitely been the case. We believe that Erectile Dysfunction(ED) should exist for true emergencies, similar to the notion that fire departments exist to extinguish fires. We think a more cost-effective, appropriate, and efficient method of treating non-emergent medical problems occurs in urgent or primary care clinics, provided these are available. At one time, our Erectile Dysfunction(ED) actually referred out persons who presented with non-emergent medical conditions. At our  Erectile Dysfunction(ED), we devised a system whereby over five years we referred over 32,000 patients to ambulatory clinics after a medical screening exam (MSE) by the triage nurse that determined these patients did not have an emergency medical condition. In subsequent years after the implementation of this referral system, referral clinics accepting non-funded patients became nearly nonexistent, making it difficult to refer patients out. We have also conducted a survey on how the general public defines a bona fide emergency and concluded most believe the Erectile Dysfunction(ED)  should be reserved for patients with true emergencies. In order to successfully treat non-emergent patients, additional primary care clinics must be built within most communities. These clinics must be able to provide services for patients with and without health insurance in order to share the patient load that currently leans heavily on the ED. A number of Federally Qualified Health Centers (FQHC)-designated clinics have opened in communities to assist with this effort, but many more are needed 2.Today’s critically ill patients require heightened vigilance and extraordinarily intricate care. As skilled and responsible health professionals, the 403 000 critical care nurses in the United States must acquire the specialized knowledge and skills needed to provide this care and demonstrate their competence to the public, their employers, and their profession. Recognizing that nurses can validate specialty competence through certification, this white paper from the American Association of Critical-Care Nurses and the AACN Certification Corporation puts forth a call to action for all who can influence and will benefit from certified nurses’ contribution to patient care 3.The decision to transfer a patient to another hospital is made after assessment of the potential risks and benefits to the patient. Indications for inter hospital transfer include the need for specialist investigation or intervention, or ongoing support not provided in the referring hospital. Non?clinical reasons for transfer include the lack of an appropriately staffed critical care bed locally, or repatriation to a local hospital.1Interhospital transfers are often made out of normal working hours, and the patient may be accompanied by relatively junior staff, leading to a high rate of critical incidents. These transfers account for up to 30% of all inter hospital critical care transport, and half of these are patients with trauma. The need for standards and training in such transfers were emphasized >10 years ago. This has been dealt with to some extent by the Safe Transfer and Retrieval course, but many trainees still lack training in the transfer of critically ill patients 4.Often, doctors use a range of terms such as “critical” or “serious” in the wake of news . But it isn’t always clear what those terms mean — and what they actually say about a patient’s condition. The terms are primarily used as a way of communicating someone’s condition to the public — not as a way of talking to patients or between themselves. As such, they serve little medical purpose, but are an important way of letting people know what is happening and aren’t scientific definitions, so aren’t always precise 5.In the UK, hospitals tend to communicate using a range of terminology. Those include words like “Critical” (usually the most concerning condition a living patient can be in) all the way through to “Comfortable” or “Progressing well”. Sometimes, people will include a suggestion of whether someone’s condition is stable, improving or getting worse. A “Critical but stable” condition, for instance, indicates that someone is in a bad state but not likely to get worse in the short-term. Others recommend against using that phrasing, however, since being in a critical condition implies that a patient vital signs are not stable 6.The US, doctors use a series of definition that are part of the American Hospital Association Guidelines:Undetermined: Patient awaiting physician and assessment.Good: Vitals signs are stable and within normal limits. Patient is conscious and comfortable. Indicators are excellent.Fair: Vital signs stable and within normal limits. Patient is conscious, but may be uncomfortable. Indicators are favorable.Serious: Vital signs may be unstable and not within normal limits. Patient is acutely ill. Indicators are questionable.Critical: Vital signs are unstable and not within normal limits. Patient may be unconscious. Indicators are unfavorable.Those guidelines also tell hospitals to only communicate their patients’ condition, so it’s unlikely that anyone will ever say any more than that. But they are also only guidelines, which mean that spokespeople can say more or less — or choose their own terminology 7.Preliminaries Clinical work during patient examination and treatment planning appointments is a highly collaborative activity involving doctor hygienists and assistants. Personnel with multiple overlapping roles complete complex multi-step tasks supported by a large and varied collection of equipment, artifacts and technology. Most of the breakdowns were related to technology which interrupted the workflow, caused rework and increased the number of steps in work processes 1.Current appointment software could be significantly improved with regard to its support for communication and collaboration, workflow, information design and presentation, information content, and data entry 2.Technique & Framework OverviewHow to Reduce Cancellations, Reschedules. Our Strategy” the first suggestion that we offers is to make a reminder call: “Appointment cards are helpful, but in the end, a phone call is your best bet.” How much of a best bet? An article on American Medical News explains that a patient is significantly more likely to keep an appointment when he or she receives a phone call reminder, according to a study from the American Journal of Medicine. Now, in a perfect world, you and your entire staff would have the time to personally call every one of your patients to remind them about their appointment. Figure.1Technique & Framework OverviewAlgorithmPatient_come;if(patient == critical){ register at reception; if(patient ==  lab/xray) { xray; if(report == ok) { leave; }else{ hospitalze; } }  else{ if(doctor checked) { leave; }else{ hospitalize; } }}else{ if(came for medical test) { register at desk; Gastro, Echo, CT Scan; consult Doctor; billing; patient Leave; }else{ if(first visit) { initial register at new patient desk; register at reception desk; }else{ register Reception desk; if(patient == lab/X-ay) { go lab/X-ray }else{ goto doctor; } } } goto Doctor if(checked) { patient clear; pay bill; leave; }else{ not clear; hospitalize; }}Experimental ResultsFor experiment on our research we visit “Ali Hospital I-9 Islamabad”. In hospital we meet Dr. Waqas Ahmed Khan(MBBS)And we describe our whole research to him. We get him permission to apply our research algorithm on this hospital and he gave us permission to apply our algorithm. “We came here three days continuously for check our algorithm if it solve the problem of critical patient or not. First day five critical patient came in the hospital and our method work correctly second day two and third day only three patients came. In three days our result was positive. After this three days experiment Dr. Waqas Ahmed Khan approve our research”. Conclusion & Future workAppointments are just for those patient who comes to the doctor for the general checkup and lightly sick not for those people which are in critical condition and the patient having appointment for the general checkup maximum time miss their appointment and reasons for missing appointments are consistent with prior research. 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