The issue of outpatient appointments not being made after an inpatient stay is a recognised issue across the NHS. This was reflected in HSIB’s evidence from staff interviews and focus groups, and examples from their previous investigations. They found that the lack of national data on the exact scale of the problem may exacerbate the issue – it is not widely reported and trusts often don’t know the intended appointment has not been booked unless informed by the patient.
HSIB examined the case of Pauline, a 54 year old woman who was discharged from hospital on two separate occasions and the intended follow-up appointments at specialist outpatient clinic were not made. Pauline had complex health issues and later died in hospital after a stay of two months. While her missed appointments did not contribute to her death, her case provided an insight into the issues that can be experienced by patients needing follow-up care.
HSIB’s national investigation identified the gaps in the assurance process behind booking outpatient appointments. They also considered opportunities for building resilience into the process to ensure timely appointments. For example, a key finding in the investigation was the lack of communication between IT systems in trusts. Joining up those systems would make it less likely that there are errors in the booking process. The report gives an example of one Trust that has fully integrated its outpatient appointment process with its IT system meaning all patients are automatically tracked and can be accounted for.
The investigation also considered the national drive to reduce the amount of in person outpatient appointments and the impact of digital transformation. They found that whilst this may improve efficiency and prevent some patients being ‘lost to follow up’, the national initiatives to transform outpatient services are not focused on building in assurance that intended appointments are made.
The report concludes with two safety recommendations that are aimed at reducing the chance that patients will be lost after an inpatient stay and supporting the staff within trusts who are responsible for arranging appointments and tracking patients.
Dr Lesley Kay, Deputy Medical Director at HSIB says “With a national focus on the use of technology and Covid-19 expediting the use of virtual appointments, the way that outpatients are seen will inevitably change. However, whether the appointment is in person or conducted virtually, the process for booking outpatients is the same. This is why it is important that the booking process is underpinned by robust assurance.
“Our investigation sought to not only show where current gaps in the booking process are but where the opportunities are to improve that process. We recognise the daily challenges facing the NHS as they tackle the fallout of the pandemic, and our safety recommendations are aimed at shifting the demand from staff to ensuring resilience and integration in the systems they use. By influencing the future design of the process, we can help ensure staff are supported and patients aren’t losing access to crucial follow-up care and treatment.”