Previous articles have highlighted the impact on the wider population, associated with redirecting health resources to meet the demand arising from the Covid-19 pandemic, and considered some potential routes to maintain access for the patients. In this article, we consider how hospitals can, through the validation of waiting lists, reduce some of this backlog and appropriately prioritize care.
In the normal activity flow in the hospital the patient, or their family doctor, requests an outpatient appointment with a specialist. They are then given a date for an appointment or added to a waiting list for an appointment to be sent out. Once patients attend their outpatient appointment and are subsequently diagnosed, they are either managed in an outpatient setting, or added to a waiting list for admission to hospital, for a period of inpatient therapy/treatment. This leads to several instances where a patient is part of a waiting list.
A lot can happen to individual patients during this waiting period, examples include:
- Elderly patients moving to another part of the country to be cared for by relatives
- The condition can resolve (if it is a minor one)
- They could have been treated in another facility (e.g. MOD, MNG, private sector)
- They could have attended as an emergency (if the condition deteriorated)
They could have moved to another part of the country (e.g. work, closer to family, etc.)
There are a lot of similar factors that would impact the appropriateness of a patient attending a specific hospital for an outpatient appointment or elective admission. From the hospital’s perspective, none of the factors are visible while there is an implicit assumption that the situation remains the same as the point at which the patient was added to a waiting list.
Waiting list validation provides a systematic approach for the engagement of patients to confirm any changes in status. This reduces the risk of sending appointments to patients who:
- No longer require an appointment/admission
- Now live in the catchment area of another facility (or in the future, cluster)
- Have or are being managed for their condition already by another provider
Evidence from the UK has indicated that validation of waiting lists can remove 5-15% of patients waiting, creating capacity to manage other patients on the waiting list.1
There are already short notice simple validation processes in place (e.g. SMS confirmation for appointments) but these are focused on reducing non-attendance and place a significant burden on administrative teams to find an alternative patient should an outpatient slot or hospital bed become available.
By adopting a structured and integrated validation of a waiting list, undertaken at regular intervals, the available capacity can be maximized thereby reducing the overall waiting time for all patients. In some countries this is a paper-based exercise, in others call centers are used but with the advent of a range of cloud-based tools there is opportunity to automate this reducing the impact on staff.
There are many models to structure the engagement with the patient, depending on the communication channel adopted with the key themes being:
- Questions focused on ascertaining if the appointment or treatment is still required, and if not why it is no longer required
- Confirmation of current address and contact details
- The availability of the patient to come to the hospital for a short notice appointment/admission
- Clearly defined context for the validation request that may including:
- The reason why they are being contacted
- The next steps if they no longer want an appointment/treatment (this usually includes a review by the specialist managing their care or communication to the source of the original referral, like a family doctor)
- Some models allow a patient to decline but that the referral is ‘kept’ for six months so that if the condition recurs, they can access a specialist in the next available non-urgent booking. In doing so, patients can feel confident to decline if they are now asymptomatic of their earlier condition.
The validation process needs to be carefully considered from a clinical risk perspective, with any referrals removed from the list being reviewed by a medical professional or communicated to the referring physician. This is important to ensure that patients with mild symptoms do not decline an appointment when there is potentially a serious underlying condition.
The aim is to build an approach that removes unnecessary waiters and ensures the most up to date patient contact information, whilst effectively managing clinical risk, to improve access for all patients.
Director - Healthcare
KPMG in Saudi Arabia