Need to improve patient flow in your hospital?

While there are many factors impacting patient flow, one of the best places to start is with outpatients. That’s because the outpatient department is part of almost every patient journey. 

So, let’s take a look at where outpatients fits into the bigger picture, potential impacts on flow, and how you can identify and improve bottlenecks in outpatients.

Most Patients Enter the Hospital System Via Outpatients

There are two ways that patients enter the hospital system. Some enter via an unplanned care pathway (emergency), while a higher percentage usually enter through planned care pathways (outpatient referrals).

In April 2022, the NHS UK reported 1.245 million finished admission episodes, of which 0.479 million were emergency admissions. This means that 61.5% of inpatient admissions originated from planned care pathways.

But the outpatient department is a part of almost every patient journey. This is where many patients start their journey, and where almost all patients — even those that come in via the emergency department — end it. 

Where Outpatients Fits Into the Patient Journey

Here are some examples of where patients might receive care from the outpatient department:

• Medical specialty referrals – If patients are referred to a medical specialty, they often receive all of their care via outpatient appointments
• Surgical specialty referrals – If patients are referred to a surgical specialty they start in outpatients then receive their treatment in an operating theatre
• Post-surgery clearance – After surgery, patients often recover as an inpatient and almost always receive their medical clearance (or are discharged) via a review outpatient appointment
• Post-emergency referrals – Patients who attend the emergency department often are stabilised in and then referred to outpatients via their GP
• Post-emergency discharge follow up – Patients that are admitted via the Emergency Department often receive a post-discharge follow up in outpatients

How Outpatient Clinics Impact the Flow of Patients

If outpatient clinic schedules are not managed (especially if there are no appointments available in upcoming clinics), hospital inpatients can often stay in hospital longer than they need. 

This tends to happen because their care provider is concerned that the patient may need to see them and won’t get an appointment. So instead of discharging the patient, they make the decision to keep them in a little longer to increase their confidence that they are ok. Essentially, care providers may extend a patient’s hospital length of stay as a way to manage risk and avoid a poor outcome, rather than using (a more suitable) outpatient appointment to do this. 

The flow-on effect is that when patients stay in hospital longer, there’s reduced capacity for other people requiring care. This means that emergency departments crowd with people waiting for a bed, emergency surgery boards fill up with people who need a bed after surgery, elective surgeries are cancelled, and waiting lists grow. All because outpatients are too busy to reliably see a patient for a post-discharge review. 

So, it's important that the outpatient department is well managed and that any bottlenecks are quickly identified and eliminated.

How to Identify and Prevent Potential Bottlenecks

Access to the outpatient department can often be a bottleneck — particularly when patients require a new appointment.

Sometimes (though rarely as we continue to experience the COVID-19 pandemic), there may be capacity further along the journey, such as time available on a day surgery list. If patients aren’t efficiently flowing through outpatients, it is difficult for hospitals to maximise or even optimise the resources available.

Keeping an eye on outpatient waitlist numbers, referrals being received, and outpatient clinic throughput can help heads of units identify where processes are getting stuck — and implement strategies and resources to keep patients flowing.

Support Patient Flow with Hospital Improvement Software

With hospital improvement software like Systemview, you can access data and charts specific to outpatients, patient flow, and every part of the hospital and patient journey. SystemView allows operational and clinical leaders to easily track outpatient waitlist numbers, incoming referrals, and other insights that help with identifying bottlenecks in outpatients and improving overall patient flow.

To learn more about how SystemView works, take a look at our guide to Getting Started with Outpatients.

Read More About Outpatients

Want to learn more? Check out our in-depth guide on Outpatient Fundamentals to dive deeper into strategies that can improve patient flow and reduce outpatient wait times, including alternative models of care, performance measures, chronological booking, and clinic effectiveness.