Most public hospitals struggle with outpatient waitlists and ensuring that every patient gets seen within recommended timeframes. The simplest explanation for this is that it’s tricky to balance clinic capacity against the demand for specialist appointments.

But this is especially difficult when your waitlists don’t reflect ‘true’ demand. In other words, some patients are on your list that shouldn’t be there (for a number of reasons). This can lead to:

Extra administrative work due to missed and cancelled appointments
Difficulty planning capacity to meet your demand
Inaccurate performance reporting (often the situation looks worse than what it really is)

This is why it’s a good idea to regularly audit your outpatient waitlists. 

So, how do you do that?

5 Ways to Audit Outpatient Waitlists

All audits have the same goal —  to refine your lists and ensure that they’re up-to-date and accurate.

 

There are five main types of audits that outpatient department managers might conduct, each with different resource requirements and criteria. But all have the same goal — to refine your lists and ensure that they’re up-to-date and accurate. 

That way, you’ll have a clearer picture of total service demand, can more easily identify which patients you need to book next, and will know how the outpatient department is performing and responding to demand.

 

1. Internal Administrative Audit

An internal audit involves administrative processes like:

• Checking data entry
• Looking for process errors
• Following up with patients to make sure they’re still waiting for treatment, still in the local area, or seeing if they’ve received care elsewhere

This type of audit is comparatively simple, but can have a significant impact. You may be able to create removals other than treatment (ROTT), instantly reducing your waitlist volume, reducing the reportable length of time to be seen, and likely reducing the volume of your long waiting patients.

2. Internal Clinical Audit

An internal clinical audit involves reviewing each case from a clinical perspective through the following processes:

• Clinicians contacting patients to check if their condition has changed or to seek further information
• Reviewing referral and patient history and checking that they are clinically ready for care
• Updating the waitlist accordingly, which may include adjusting clinical priority (if required)

The clinical audit is more resource-intensive, but is often worthwhile due to the potential impact. The result is that you’ll end up with a more accurate, up-to-date waitlist that better reflects demand. And you’ll be in a better position for prioritising patient needs to achieve the best clinical outcomes.

3. External Administrative Audit

Similar to the internal administrative audit, an external administrative audit can be a low-resource way to review waitlists — and is done by an external party. You might outsource your administrative audit activities when your internal teams don’t have the capacity to do an audit themselves. This kind of audit is particularly valuable for category 2 and 3 referrals that may have been waiting for several months.

4. External Clinical Audit

An external clinical audit involves bringing in an external clinician to review your waitlist from a clinical perspective. Similar to the internal clinical audit, it often involves contacting patients to confirm their status, checking readiness for care, and more. It could also involve requesting an updated referral from each patient’s GP or specialist. 

This process can be time-consuming, particularly due to the collaboration and preparation that goes into it. But it can also have a high impact by ensuring you have more up to date information on each patient’s condition to better prioritise their care, or recommend alternative options. And unlike an internal clinical audit, it doesn’t rely on your existing team for input, which frees them up to focus on patient care.

5. Clinical Referral Audit

A clinical referral audit is a bit different to the previous four audits in that it doesn’t look at who is on your list, but how they got there. Reviewing your waitlists by referral source can often provide useful insights that help you refine your referral processes.

Reviewing your waitlists by referral source can help you refine your referral and booking processes.

 

For example, you might look at your top 5-10 referred conditions and check things like whether the referral was complete and appropriate — and whether alternative models of care could apply. 

If you notice a trend where certain referral sources are regularly sending incomplete or inappropriate referrals, this may present an opportunity to educate the clinician or update your policies to improve referral quality in the future.

So, When Do You Start Auditing?

Most people who have worked in Outpatient Referral Centres or manage waitlists as part of their speciality are familiar with planned audits that occur at scheduled times. 

For example, it is very common for large audits to be conducted twice a year — perhaps in December and June. This is to ensure that the waiting list is in good working order. 

Auditing is very effective for end of year reporting, as it typically removes a large number of erroneous records. But as time goes on, the waitlist becomes a little more unreliable again and staff become less trusting of the data or reports. This is why auditing can be most effective if it is built into routine practice.

Embedding Auditing Into Daily Routines

Making auditing more routine means having designated people who have a daily responsibility to select patients on the waiting list and check that they are:

• Still waiting for an appointment
• Still haven’t received their treatment
• Still have the correct details so that they can be contacted when the appointment is offered

Plus, making sure there are no errors on their referral record that might impact whether they will be seen on the waiting list and called. For example, making sure they’re not erroneously getting booked into an appointment 30 years from now.

Routine audits are helpful for managing clinical risk in the outpatients department. If the patient is regularly contacted, they may declare they have worsening symptoms and inform someone at the hospital that their urgency may need to be upgraded. The audit will allow the hospital to advise the patient to get an updated referral from the GP that will assist with re-categorisation.

Routine auditing also allows staff to identify regular administration or data entry errors that are being made by internal hospital staff. These insights can then be used to inform onboarding and training programs, guidelines, and standard operating procedures. This can lead to a more capable workforce as well as a consistently-reliable, up-to-date waiting list.

Get Started with Your Audit

So, which audit should you start with? That depends on where you suspect your biggest challenges are — and what resources you have to work with. It’s a good idea to go for any low hanging fruit, so if you can, start with an audit that doesn’t require too many resources.

You might start with an internal administrative audit and/or look at your longest waiting patients first, as their information is more likely to need updating. This may give you some quick wins that build momentum for a more thorough, resource-intensive audit.

Go for low hanging fruit and get some quick wins that build momentum.

Use Software for Waitlist Audits

SystemView is the ideal tool to support a clinical and administrative audit of your outpatient waitlists. 

Inside SystemView, you can easily find your longest waiting patients to start following up with them first. Or you can build a workbook that highlights patients with error records or statuses that suggest they may not require an appointment (for example, you can identify patients who may be deceased). You can even create a Hub specifically for monitoring your outpatient long waits with targeted charts and patient lists that you want to refer to over and over again.

See more features in our Getting Started with Outpatients Guide.

Explore More Outpatient Waitlist Management Strategies

Want to learn more? Check out our Outpatients Fundamentals Guide to dive deeper into this topic, including strategies like alternative models of care, performance measures, chronological booking, and clinic effectiveness.