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Shorter waits, whatever your waiting list

14/12/2010
by Rob Findlay

A new video shows the power of better patient scheduling to reduce waiting times. It shows waits falling from 20 weeks to 14, just by managing bookings better.

What made the difference?

  • the right number of slots was reserved for urgent patients
  • urgent patients waited as long as was clinically safe for them
  • only genuinely urgent patients were declared urgent

The video tells the story by itself. So let’s look instead at something the video doesn’t cover…

Follow-up outpatients

Imagine this: You are booking referrals into outpatient slots. Every routine patient gets the next available slot. You’re busy, and all slots are fully booked up for the next few weeks. Then an urgent referral arrives, and the patient needs to be seen quickly. But all the early slots are full. The only way to squeeze them in is to cancel someone else. But who?

In the video we assumed that a routine first appointment would be cancelled – whoever is least inconvenienced by the delay. But many hospitals prefer to cancel follow-up patients instead (usually two or three, in fact, because follow-up appointments tend to be shorter than new appointments). This lets them make space for the urgent patient, without putting extra pressure on their 18-week waiting time target by delaying a first appointment.

So which is better? If you have to cancel patients, should you cancel one routine first appointment, or two (or three) follow-ups?

To answer this, we need to look at follow-ups more closely. A follow-up patient should (if referred appropriately) be someone who needs to be seen during a specified window of time: for instance 2-4 weeks, or 5-8 months, after their previous appointment.

The first thing to point out is that some patients are followed-up unnecessarily, so the first priority should be to ensure that patients are only followed-up for the right reasons. Clogging up the clinic with unnecessary follow-ups is a waste of clinicians’ time, and the patients’.

Now let’s look at this time window. If the patient could just as well be followed-up after 8 months as 5, then it makes sense to go for 8 months. Why? Because it reduces the number of follow-up appointments in any given year, releasing capacity for other work. Otherwise you end up seeing patients more often than necessary, which again wastes everybody’s time.

But there is a consequence. Once the patient reaches the 8 month mark, they really do need to be followed-up now. In effect, they are clinically urgent. So we can’t cancel them. We should cancel a routine first appointment instead, if we have to.

So the story told by the simulation video is the right one. We should cancel routine first appointments, not follow-ups, if we need to make space for urgent referrals. As the simulation shows, it is possible to do this and keep waiting times to a minimum.

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