Booking patients from the outpatient waitlist is an important function in the hospital — one that comes with complex considerations. 

There are a limited number of available bookings in every outpatient clinic and nearly always more patients waiting to be seen than available space — each with varying urgency and wait times. Choosing one patient over another requires you to consider each individual case in the context of risk factors, clinical recommendations, and fairness.

So, how do you decide who goes next?

Let’s take a look at one scenario and two different approaches.

A Common Scenario

Consider this scenario…

You have three appointments available next week to fill and four the following week. Three new referrals are received for urgent patients who need to be seen within the next 30 days.
 
What would you do?

Approach #1: Booking Urgent Patients First

One of the most common booking practices we see is that urgent patients are identified and booked first. This ensures that the patient with the highest perceived risk is being cared for — but it often leads to only these patients being seen, and those less urgent waiting on the list indefinitely.

Here’s what we see happen a lot of the time when hospitals are faced with the above scenario:

Book urgent patients first Book all three of this week’s appointments with the new referrals Keep next week’s slots open for new urgent referrals, with maybe a little surplus for less urgent patients The following week, three urgent patients come in again, and you fill the last appointment with 1 routine patient who has been sitting at the top of the waitlist

At face value, it makes sense to see the urgent patients first. But to make the right decision, you need more context. 

The Problem With Prioritising Urgency

If when you’d received the first three urgent patients, you’d reviewed them alongside the patients who have been waiting (and were approaching the end of their clinically recommended wait time), you would have noticed something important… 

Two routine patients have waited over a year for care when their recommended time was three months.

With this information, you would then need to assess who was truly more urgent — the overdue (long wait) patient? Or the urgent patients?

It’s important to note that your urgent patients (in this scenario) can wait up to 30 days and have only waited one day. So, do they really need to be seen this week? Possibly — and it’s important to confirm this with a clinician — but often waiting a little longer within their waiting time is safe. 

In which case, perhaps there’s a better approach…

Approach #2: Book a Mix of Urgent & Routine Patients Based on Wait Times

Once you have the additional context surrounding each patient on your waitlist, you could potentially:

Book a mix of urgent and routine patients based on clinically recommended wait times Fill two appointments this week with long waits Fill the remaining appointment with one of the urgent patients Reassess what to do with next week’s vacancies

Depending on the number of urgent referrals you receive per week, you may wish to wait a little longer before filling them. Or you may go back to the top of your waiting list and book the next in turn.

Booking a Mixture of Patients Reduces Long Waits

One of the simplest and most effective ways to reduce outpatient long waits is to consider both urgency and time-based risk when booking.

Each week, you will ideally book a mix of patients across all categories to get the most patients seen within target times so that you can either avoid long waits or (if you already have them) bring your long waits or overdues down. 

Obviously, this is not possible if you don't have enough capacity to see all your patients in time, but it can often feel like you don’t have enough capacity because of how you are booking.

One of the simplest and most effective ways to reduce outpatient long waits is to consider both urgency and time-based risk when booking.

Coming back to the scenario above, if you were booking only with urgency in mind, it would have felt like there was no room for the two overdue patients. There was only room for one to be booked the following week, and the others would need to wait until another ‘surplus’ arrived. 

But if you were booking with urgency and time-based risk in mind, the two overdue patients were booked and (after their appointments removed from the waiting list) all the urgent patients got a booking too — well ahead of their treatment time.

Use SystemView Wait Groups to Support Booking Processes

Without the right systems in place, it’s tricky (and time-consuming) to get enough context around each patient on the waitlist to identify which patient needs to get booked next — especially with dynamic waitlists that change on a daily basis. Fortunately, hospital improvement software can help to automate this process and support decision making (while saving your bookings team time).

SystemView has a built-in time-based risk logic that places patients into different wait groups in order to support operational and clinical booking practices. 

Our Outpatient Waiting List Risks & Projections component displays your current referrals (across all categories) that are at risk of breaching their clinically recommended time frame so that you can book these patients first. 

Find this component in SystemView: SystemView > Outpatients > Waiting List > Risks & Projections

And our Outpatient Patient List component is automatically ordered so that you can see the most urgent patients, as well as those less-urgent or routine patients who have waited too long or are due for care.

Find this component in SystemView: SystemView > Outpatients > Waiting List > Patient List

Read More About Outpatients

Want to learn more? Check out our in-depth guide on Outpatient Fundamentals [hyperlink when ready] to explore other challenges and strategies for outpatients, including alternative models of care, performance measures, chronological booking, and clinic effectiveness.