Outpatient appointments intended but not booked after inpatient stays

HSIB legacy content

This investigation was carried out by the Healthcare Safety Investigation Branch (HSIB). Find out more about HSIB legacy.

National investigation

We identified a safety risk involving outpatient follow-up appointments which are intended but not booked after an inpatient stay.

If a patient does not receive their intended follow-up appointment, it could lead to patient harm owing to delayed or absent clinical care and treatment.

Reference event

The investigation was launched after HSIB identified an event where a patient was discharged from hospital on two separate occasions with a plan to follow-up in outpatient clinics. Neither of the outpatient appointments were made.

People attend hospital for a variety of reasons including diagnostic tests and treatments. Some people may need to stay for one night or more in hospital and are known as ‘inpatients’. Some people may only be required to attend appointments at clinics without an overnight stay. These people are referred to as ‘outpatients’. Commonly, after an inpatient hospital stay, people may be seen at a future date in an outpatient clinic to review their progress or agree next steps for their treatment.

Investigation summary

This investigation:

Identified factors which compromise the booking of outpatient follow-up appointments after an inpatient stay.
Considered opportunities for building resilience into the booking process for follow-up appointments.

Safety recommendations

NHS England and NHS Improvement

HSIB recommends that NHS England and NHS Improvement develops standards and an operating framework that describes the assurance required for all outpatient appointment booking processes, including after an inpatient stay.

The assurance should include feedback mechanisms which provide safeguards that intended outpatient appointments are booked. Ideally, solutions will use technology and automation to create resilience and efficiency so that there is less reliance on staff vigilance.

We are working to minimise the risks highlighted in the report by freeing up capacity to oversee patient appointments, while supporting organisations to prioritise patient lists. We are working with NHSX so that tech and digital developments, including automation of processes, align and support our outpatient improvement programme in maximising quality of patient care.

We will continue to work with organisations to help them validate and prioritise patient lists to ensure timely patient care. This will include outpatient care as part of a system-wide priority to recover NHS services following the impact of the pandemic.

Through the work of our Outpatient Transformation Programme, reduction in the volume of necessary appointments will create capacity to help ensure that delayed and missed appointments are not ‘lost in the system’.

Our Improvement team will work closely with NHSX to ensure tech and digital developments, including the automation of patient administration and booking systems, support the improvement of care pathways and transitions (of both patients and information) between care settings and improve the resilience of current systems. Timeline: 2021/22.

Response received on 9 August 2021.

NHSX

HSIB recommends that NHSX’s What Good Looks Like programme includes a requirement for organisations to be responsive to HSIB reports and recommendations within the ‘Safe Practice’ section of its guidance.

NHSX have actioned this recommendation and it will be published in the What Good Looks Like guidance. Timeline: Complete.

Response received on 23 July 2021.

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