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.