Fitting a same-day add-on home visit into planned routes
Updated October 8, 2026 · 2 min read
Insert the add-on visit where it adds the least time without pushing any later visit past its window or the clinician past the end of the shift. Test every clinician with the right skill, including those farther away, and change as few existing assignments as possible.
Check what the visit needs
- A clinician with the required skill. Routing models treat qualifications as a fixed rule.
- A time window: when the patient can be seen and, for a medicine or test, when it has to happen.
- Room in the rest of the day: every later visit must still start inside its window, and the route must end before the shift does, breaks included.
- Continuity: if the patient already has a usual clinician, try that person first.
Insert, step by step
- 1
Freeze what has happened
Visits done or in progress stay put. Plan from where each clinician will be next.
- 2
List the gaps
For each qualified clinician, every gap between two remaining stops is a candidate, and so is the end of the route.
- 3
Price each gap
The extra drive is the drive to the new stop plus the drive from it to the next stop, minus the drive that gap had before. Add the visit length and any wait for the new window.
- 4
Push the day forward
Recalculate every later arrival and check each window and the end of the shift.
- 5
Pick the cheapest gap that works
If no gap works, offer the patient a later window or another day, or move a visit with a wide window to someone with room.
This method is called insertion. Solomon's 1987 study of routing with time windows found that an insertion-type method consistently gave very good results, and several home care routing studies use cheapest or best insertion to build their starting plans.
Worked example
A nurse is with patient C until 10:30. Still to come are D (window 09:00 to 15:00, 60 minutes) and E (window 12:00 to 14:00, 30 minutes), then the office, which puts the end of the day at 12:55. At 10:00 a request arrives for patient F: 30 minutes, window 11:00 to 13:00. Drive times: C to D 10 minutes, D to E 25, E to office 20; C to F 15, F to D 20, D to F 10, F to E 20, E to F 15, F to office 25.
| Insert F | Extra drive | Waiting | Back at office | Windows met |
|---|---|---|---|---|
| Between C and D | 25 min | 15 min | 14:05 | Yes |
| Between D and E | 5 min | 0 min | 13:30 | Yes |
| After E | 20 min | 0 min | 13:45 | Yes |
Between D and E costs 35 minutes in all, the visit plus 5 minutes of extra driving: F starts at 11:50 and E at 12:40, both inside their windows. Before committing, run the same test for any other nurse with the skill whose route passes near F. The full morning is in home visit route planning.
Capillary's routing, shown as a demo, plans home visits for clinicians, couriers and equipment around visit windows, skills and travel time. See Capillary for hospital-at-home programs.
Common questions
- Should the closest clinician always take the add-on?
- No. The closest clinician may have a tight window later in the day that the extra visit would break, while someone farther away has slack. Compare the added time for every qualified clinician.
- How do we keep continuity when re-planning?
- Offer the add-on to the patient's usual clinician first, and keep existing patient and clinician pairs wherever a workable gap allows. Routing research names continuity as something to preserve during re-planning.
- What if no gap works today?
- Offer a later window or the next day if the visit allows it, or move a visit with a wide window from the busy clinician to someone with room, then test the insertion again.
Plan home visits around windows, skills and drive time.
Capillary's routing module plans the day for clinicians, couriers and equipment. See it with sample data.