Booking patients for hospital admissions: evaluation of a pilot programme for day cases

Abstract

Problem: NHS patients requiring elective surgery usually have to wait before being treated and are usually told when a date becomes available.

Design: 18 month pilot programme to enable day case patients to book date of hospital admission at time of decision to operate.

Background and setting: 24 pilot sites in England with relatively short waiting times and some experience of booking appointments.

Key measures for improvement: Proportion of patients with booked or "to come in" date during and after pilot programme, proportion not attending for admission, and proportion waiting > or = 6 months. Comparison of pilot sites with non-pilot sites.

Strategies for change: National Patients' Access Team established to help pilot sites enable patients to book admission dates. Provision of 9.9m pounds sterling to pilot sites to employ project managers, purchase equipment, buy extra time from clinical and other staff, and invest in information and communications technology.

Effects of change: Proportion of patients with booked or "to come in" date increased from 51.1% to 72.7% between end of March 1999 and end of March 2000, and then fell to 66.2% by end of March 2001. Over the same periods, the proportion of patients waiting > or = 6 months fell from 10.9% to 10.5% and then increased to 11.9%. The proportion of patients failing to attend fell from 5.7% to 3.1% between the first quarter of 1999 and the first quarter of 2000, and then increased to 4.0% in the first quarter of 2001. Pilot sites varied widely in performance during and after the pilot phase. Pilot sites had higher proportions of patients with booked or "to come in" date than non-pilot sites at end of each period.

Lessons learnt: Increasing the proportion of patients who book their date of hospital admission is possible, but there are difficulties in sustaining this. Several factors facilitated or hindered the implementation of booking, and the roll out of the programme across the NHS is seeking to incorporate these factors.

Fig 1

Percentage of patients awaiting day case admission with booked admission date or “to come in” date at 20 pilot sites in first wave of the National Booked Admissions Programme, and scope of pilot sites (proportion of all day cases in the participating trust or trusts)

Fig 2

Percentage of patients awaiting day case admission who failed to attend a booked appointment in 17 pilot sites in first wave of the National Booked Admissions Programme

Fig 3

Percentage of patients awaiting day case admission who waited ≥6 months for admission in 20 pilot sites in first wave of the National Booked Admissions Programme

Fig 4

Percentage of patients awaiting day case admission with a booked or “to come in” date and percentage waiting ≥6 months for admission in the pilot sites in first wave of the National Booked Admissions Programme and in all other NHS trusts in England in relation to current targets (all data from KH07 central returns)