Design and analysis of an outpatient orthopaedic clinic performance with discrete event simulation and design of experiments

•This paper evaluates different patient flows (one, two or three-step trajectories).•Our model is a more realistic representation than theoretical queuing models.•The model shows that 2 exam rooms instead of 3 can be used for all patient flows.•Modifying appointment scheduling rules reduces significantly patient lead time.•Appointment scheduling rules must be determined according to patient flow types. Considering that demand for healthcare services is constantly increasing, outpatient services must improve their performance. Being able to satisfy the demand with a limited outpatient service capacity is an important operational challenge. The objective of our research consists in studying the relationships and interactions between patient flows, resource capacity (number of consulting rooms and number of nurses) and appointment scheduling rules in order to improve an outpatient orthopaedic clinic performance. Discrete event simulation is used to model outpatient flows. An experimental design was developed to test how to assign consulting rooms and nurses to each orthopedist considering four appointment scheduling rules and three patient flow types of varied complexity. Analysis of variance and the Tukey test are used to evaluate the simulation results. Our conclusion is that in order to improve the outpatient orthopaedic clinic performance, resources (consulting rooms, nurses) and appointment scheduling rules must be adapted to the different patient flows.