Inefficient processes in the management of outpatient waiting lists meant one patient – whose care was defined as urgent – was left waiting over 400 days for an appointment date, found an audit by the National Treatment Purchase Fund (NTPF).
Published in March this year, the audit took place between May 2024 and November 2024. It was released to the Medical Independent through Freedom of Information law.
The audit and quality assurance report on outpatient data across a number of hospitals found that for 18 patients with a clinical prioritisation category (CPC) of urgent, appointment dates were not scheduled within 28 days of their referral date, as recommended by the NTPF.
The timeframe instead ranged from 42 to 147 days, with one patient waiting 427 days.
The CPC is the level of urgency a clinician assigns to a referral, which can be categorised as urgent, semi-urgent, and non-urgent.
An examination of semi-urgent referrals found that 11 patients were not given appointment dates within the 13-week recommended timeframe from the referral received date.
Instead, the timeframes ranged between 15 and 55 weeks. The findings were among a number of issues identified in the audit report, which was titled Scheduling of Outpatient Appointments and Management of the Did Not Attend Process in Line with the National Outpatient Waiting List Management Protocol 2022.
Outpatient waiting list data relating to 269 patients from seven unnamed public hospitals were reviewed for the audit.
Two areas were examined: The scheduling of outpatient appointments and the management of patients who did not attend (DNA) their outpatient appointment.
The audit sought to examine whether national protocol was followed and identify issues impacting the accuracy of data submitted to the NTPF.
A patient’s start time on outpatient waiting lists should begin on the date the referral was received by the hospital.
Of the 269 referrals reviewed, 87 per cent were confirmed as having a referral received date recorded, the audit showed.
Correct referral entry dates onto hospital patient administration systems (PAS) are important as the date marks the beginning of a patient’s waiting time for care.
The audit found that for 73 patients where the referral date did not match the date entered onto the PAS, the discrepancy in start wait time ranged from one to 13 working days.
In three cases, the delay was greater – 44, 69, and 140 working days.
According to national protocol, patients should be given a minimum of two weeks’ notice of their appointment. The appointment date should also not be scheduled more than six weeks into the future.
However, in many cases, patients were given appointments outside this timeframe, with one scheduled 148 weeks later.
The examination of the management of DNAs revealed “low compliance levels”, particularly regarding patients assigned a CPC of non-urgent and semi-urgent across all hospitals.
The NTPF recommended that hospitals consider managing and processing referrals in a centralised administration office “to ensure standardisation of processes across all specialties”.
The audit revealed there were three referral management systems in use across the seven hospitals.
Referrals were managed either by a central referrals office, at specialty level, or by the individual consultant secretary.
“This overview report draws together cumulative key findings and trends from the comprehensive analysis of the audits conducted in seven hospitals across the HSE health regions and the Children’s Health Ireland Group,” the report stated.
“It provides information and insights to stakeholders on current outpatient scheduling and DNA management processes, highlighting areas for improvement and adherence to national protocols.
“Based on audit findings, clear opportunities for improvement and efficiencies were identified to a greater or lesser extent across all hospitals which were addressed in the individual hospital reports.
“Senior stakeholders within the health regions and HSE acute Access and Integration have received individual hospital reports; it is our expectation that they will oversee the level of progress achieved in relation to addressing audit recommendations.”
The report stated that the NTPF recognised the “significant challenges at hospital level”. The NTPF would “continue to provide guidance to hospitals” through training and education on the protocol to enhance administrative efficiencies in the delivery of timely and equitable access to outpatient services.
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