Managing Inpatient Waiting Lists

Bedford Hospital

Trust

Bedford Hospital NHS Trust

Examining the Management of
the Inpatient Waiting List

© 2003 Peter Louis. All Rights Reserved

Bedford Hospital NHS Trust


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Contents
Contents .............................................................................................................. iii
Glossary ................................................................................................................ v
Executive summary............................................................................................... 1
Background ........................................................................................................... 3
Methodology ......................................................................................................... 4
The NHS and Bedford BHS Trust...................................................................... 4
The waiting list process ..................................................................................... 5
Process maps.................................................................................................... 6
Results & findings ................................................................................................. 9
Specialities ........................................................................................................ 9
Ear, Nose and Throat .................................................................................... 9
General Surgery and Urology ...................................................................... 11
Gynaecology ................................................................................................ 18
Ophthalmology............................................................................................. 20
Oral Maxillo-Facial ....................................................................................... 22
Trauma and Orthopaedics ........................................................................... 23
Support departments ....................................................................................... 26
Accident and Emergency ............................................................................. 26
Admissions Department ............................................................................... 26
Bed Manager ............................................................................................... 27
Critical Care ................................................................................................. 28
Inpatient PAC............................................................................................... 28
Medical Records .......................................................................................... 28
Outpatient Process ...................................................................................... 29
Reginald Hart Inpatient Ward....................................................................... 29
Tavistock Day Case Ward ........................................................................... 30
Theatre Process .......................................................................................... 31
Waiting List Department............................................................................... 31
Waiting List Manager ................................................................................... 33
Discussion .......................................................................................................... 35
Outpatient clinic ............................................................................................... 35
Allocation of TCI dates .................................................................................... 37
Creation of theatre schedules.......................................................................... 42
Managing patient cancellations ....................................................................... 44
Managing DNAs .............................................................................................. 46
Managing hospital cancellations – surgical fitness .......................................... 49
Managing hospital cancellations – hospital resources..................................... 53
Use of PiMS .................................................................................................... 54
Further action ...................................................................................................... 55
Waiting list management best practice ............................................................ 55
Centralised versus decentralised Admissions ................................................. 55


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Day surgery ..................................................................................................... 55
Effect of ward processes on the management of inpatient waiting lists ........... 55
Acknowledgements ............................................................................................. 56
References.......................................................................................................... 57
Appendix A – PiMS ............................................................................................. 59
Appendix B – Targets and guidelines ................................................................. 63
Waiting List Targets ......................................................................................... 63
Waiting List Guidelines .................................................................................... 64
Placement and Removals ............................................................................ 64
Primary Targeting Lists ................................................................................ 66
Inpatient and Day Case Procedures ............................................................ 66
Pre Assessment........................................................................................... 67
Monitoring Cancellations and DNAs ............................................................ 67
Guidelines Developed by the Trust ................................................................. 68
Appendix C – Interview scope............................................................................. 69


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Glossary
Checklist:
Checklist is a piece of software widely used for waiting list management.
Clinical priority:
This defines the priority given to a patient during an outpatient appointment.
Clinician:
A health care professional engaged in the care of patients, as distinguished
from one working in other areas. Specifically, within the process maps
developed, “clinician” refers to a consultant or less senior doctor.
Consultant team:
This team includes all the staff that work with the consultant in assigning TCI
dates to patients.
Critical care:
Health care provided to a critically ill patient during a medical emergency or
crisis.
Day case/surgery:
A surgical procedure for elective patients where patients return home on the
same day on which the procedure is performed.
DNA - Did Not Attend:
A DNA is a patient who fails to turn up for an appointment, PAC or operation
without giving prior notice.
Domain Expert
This individual has detailed knowledge of a process, activity or event.
DTA - Decision to Admit:
The decision made by a clinician during an outpatient appointment that a
patient needs further treatment.
Elective Patient:


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A patient admitted to hospital for a planned procedure after an outpatient
consultation.
Emergency:
Service offers care to patients who arrive with urgent problems and who have
not usually been seen previously by a general practitioner
Emergency bed service:
This service covers the assignment of beds to the emergencies arrived at the
hospital.
GP - General practitioner:
These doctors provide family health services to a local community. They are
usually based in a surgery or GP practice and are often the first port of call for
most patients with a concern about their health. GPs refer patients who need
more help to specialists, such as hospital consultants.
House officer:
An intern or resident employed by a hospital to provide service to patients
while receiving training in a medical specialty.
Inpatient:
Persons admitted to health facilities which provide board and room, for the
purpose of observation, care, diagnosis or treatment.
Medical Records:
The department that holds information concerning patient medical history.
Nurse Practitioner:
A registered nurse with advanced training in a particular area of health care,
e.g., paediatric nurse practitioners has additional education in the care of
children.
O/P – Outpatient
A patient referred to a consultant by a GP or consultant.
O/P referral letter:


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A letter sent by the Consultant to a patients referrer to inform them of the
outcome of the outpatient appointment
O/P Clinic:
An administrative arrangement enabling patients to see a health professional
at a consultant clinic, nurse clinic, midwife clinic, family planning clinic, or at
any other clinic.
Outlier:
An outlier is a patient who occupies a bed in an incorrect ward i.e. a urology
patient in an orthopaedic ward.
PTL – Primary Targeting List:
The PTL is the list provided by the Waiting List Department outlining the
patients with the longest waiting time and therefore highest priority.
PAC - Pre-Assessment Clinic:
A clinic that assesses general health and fitness of patients for surgical
procedures.
PAAF - Patient Awaiting Admission Form:
A form that details patient information, procedure and TCI date.
PiMS - Patient Information Management System:
PIMS is the Patient Information Management System used by Bedford
Hospital NHS Trust.
Preoperative care form:
The preoperative care form is filled by a nurse on the ward before surgery
takes place
Referrer:
The Referrer is the healthcare worker who referred a patient to the hospital
Referral letter:
This provides information on the patient and the reason for referral to a
consultant
Registrar:


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This grade of medical staff is a member of a consultant‟s team.
Routine:
That is the name given to a usual, habitual, regular clinical priority.
Senior clinical officer:
SHO – Senior House Officer:
Side of Operation:
The area to be operated upon in theatre must be marked before surgery can
go ahead. This must be done by a clinician qualified to carry out the surgery.
Soon:
That is the name given to a case that needs to be attended faster than a
routine clinical priority.
Specialist:
One who devotes himself to diseases of particular parts of the body, as the
eye, the ear, the nerves, etc.
Surgical case:
The surgical case relating to an operative procedure.
T-Card:
These cards are used to record patient information, mainly at the Trauma and
Orthopaedics specialty.
T-Card board:
This board is used to display the T-card of each patient, and is a visual tool to
manage the state of each patient on the waiting list.
TCI date – To Come In date
The date when a patient is scheduled to attend the hospital for a procedure


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TCI list:
The list shows the patients that have been given TCI dates.
Theatre list:
The list shows the date of operation for each patient and the resources
assigned to each of them (theatre, ward, time …)
Tracer:
Medical Records enter the person/dept to which patient notes are booked out
from the library on a tracer
Waiting list:
The patients awaiting an inpatient or day case procedure
Walk in patient:
This is name given to patients who have their PAC on the same day as their
outpatient appointment.


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Executive summary
The Inpatient Waiting List Project was initiated in February 2003 by Bedford
Hospital NHS Trust in cooperation with Cranfield University to look at the
inpatient waiting list process The aim was to provide a set of observations
that would provide insight into how the process could be improved.
The objectives of the project were to:


acquire knowledge of inpatient and day case management processes



acquire knowledge of the use and capabilities of relevant information
systems



construct and analyse the „AS-IS‟ maps of the processes.

Cranfield University was contracted to investigate the waiting list process of
six surgical specialities and the administrative and clinical departments that
were an integral part of the process. In total, 53 staff members at the Trust
were interviewed. A complete list is provided in the Interview Scope in
Appendix C.
The methodology used by the team to achieve the objectives of the project
consisted of a number of key stages:
1. Understanding the NHS and Bedford NHS Trust
2. Investigating and understanding the inpatient waiting list process at the
Trust
3. Developing process maps to represent the inpatient waiting list process at
the Trust
4. Analyzing the IDEF3 process maps to develop observations

The main observations were:
1. Evidence of unclear working practices. The process maps indicated
that on occasions, there were no clear channels of communication or
ownership of responsibility for reporting information on, for example,
DNAs or cancellations, within Trust.
2. There was duplication of both data and effort. Patient information was
stored external to PiMS in private information stores, such as Access,


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diaries or T-Boards. Moreover, information that was already contained
in PiMS, such as which patient and TCI information, was re-entered
into PiMS by the Theatre Department to create the operating list of
each consultant.
In conclusion, scope exists to standardise the waiting list management
process by examining what best practices are performed within the Trust to
reproduce those practices within the waiting list processes of other
consultants. This report contains the in-depth knowledge required in order to
achieve this.
Nonetheless, other areas that may be considered include:


benefits of having a decentralised admission process versus a
centralised admission process



whether opportunities exist to undertake more surgical procedures as
day surgeries



a survey of best practice knowledge among other clinical and ward staff
not interviewed as well as patients.


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Background
Bedford Hospital NHS Trust is a dynamic organisation open to new ideas that
improve patient services. The hospital management team is working to
achieve the implementation of a successful Inpatient Waiting List
Management Policy.
One of the main purposes of the NHS Plan is to improve waiting times for
patients. To improve the inpatient waiting list at Bedford Hospital, firstly, the
hospital wanted to better understand the process. To achieve this, the
following objectives were identified to:


acquire knowledge of inpatient and day case management processes



acquire knowledge of the use and capabilities of relevant information
systems



construct and analyse the „AS-IS‟ maps of the process.


3

Methodology
The methodology used by the team to achieve the objectives of the project
consisted of a number of key stages:
1. Understanding the NHS and Bedford NHS Trust
2. Investigating and understanding the inpatient waiting list process at the

Trust
3. Developing process maps to represent the inpatient waiting list process

at the Trust
4. Analyzing the process maps to develop observations

To implement the above four-stage methodology, the team utilized a set of
project management techniques and tools. The MOT (setting a Mission,
determining a number of Objectives and specifying a series of Tasks) project
planning and management methodology was closely followed. To support
MOT, the project team had weekly team meetings that monitored the project
against the plan and against the budget.

The NHS and Bedford BHS Trust
This required that the team investigate and understand the drivers for change
within the NHS:


The need to reinvest in the NHS after several years of neglect



The need to make NHS more efficient and effective at delivering
services catered towards its customer – the patient

Although the NHS is the largest organisation in Europe, investment levels in
real terms have been falling steadily and investment within the NHS is lagging
behind investment levels in similar institutions within Europe.
Associated with this lack of investment, NHS working practices have changed
little since its beginnings. The NHS Plan promised real investment, but this
had to be linked to changes that made the organisation more effective at
delivering patient services at cost savings to the public. However, cost
savings brought through improvements in effectiveness and efficiency were to
be reinvested in the NHS to deliver more services.


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Coupled with these drivers for change were a set of guidelines and targets
that were set by the Department of Health and various agencies and
independent bodies. These targets and guidelines were investigated to
determine how they applied to the management of inpatient waiting lists.
Additionally, the team investigated the Trust, to understand its history, its
problems and the role the Trust played within the Bedfordshire community.

The waiting list process
This phase of the project methodology required that the team investigate the
inpatient waiting list process at the Trust. Firstly, however, it was necessary
to establish the project data requirements:
1. Data scope – what specialities and departments were to be mapped
2. Data sources – those persons or systems that would provide

information and data on the waiting list process
3. Data content – what information was going to be elicited from the

various persons or systems
The data scope, sources and content were initially identified by visiting the
hospital‟s website, by talking to the project sponsors about candidate
departments, by talking to the course supervisors who have experience in
assisting the NHS through the Modernisation Agency and by having a series
of introductory meetings with several key staff members at the Trust.
The data scope and sources were finalised by asking the project sponsors to
provide a set of specialities and departments, and a corresponding list of
individuals who should be interviewed. This list included 53 staff members:

Group

Department

12 Consultants

ENT - 3
General Surgery - 2
OMF - 1
Urology - 1
Trauma & Orthopaedics - 1
Gynaecology - 2
Anaesthesia - 2

23 Consultant secretaries

Ophthalmology


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ENT
General Surgery
OMF
Urology
Trauma & Orthopaedics
Gynaecology
18 Support and clinical staff

Waiting List Manager
A+E Manager
Day Case Manager
Bed Manager
Admissions Department
Waiting List Department
Theatre Manager
Ward Clerk
Medical Records
Department of Anaesthesia
Pre-assessment Clinic
Outpatient Department

The initial visits to the Trust also allowed the team to discover various sources
of quantitative data that could be investigated. These sources were:


Checklist



Patient Information Management System (PiMS)



Cancelled Operations Diagnostic Toolkit

The team then arranged a set of interviews and information requests to elicit
information from the identified data sources. However, the team determined
that data from PiMS was fed into the Cancelled Operations Diagnostic Toolkit
and the Checklist capacity planning application. Hence, the team decided to
focus on collecting data from PiMS.

Process maps
In parallel to collecting data and interviewing hospital staff, the team
developed the IDEF3 process maps of the waiting list process.
The IDEF3 method was chosen to describe and document the processes as it
captured knowledge in a structured way and within the context of a scenario
(story). This scenario then provides an overall view that can be decomposed
into other processes. Furthermore, IDEF3 captures precedence and causality


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relationships between situations and events in a form that is natural to domain
experts. The main advantages of IDEF3 are:


Records the raw data resulting from fact-finding interviews in systems
analysis activities



Determines the impact of an organisation's information resource on the
major operation scenarios of an enterprise



Documents the decision procedures affecting the states and life-cycle
of critical shared data, particularly manufacturing, engineering, and
maintenance product definition data.



Makes system design and design trade-off analysis.

The IDEF3 maps were to be created after a debriefing of the interviewer and
within one or two days of the knowledge being captured. To standardise map
development, the team agreed and followed the following procedures:
1. Processes, actions, activities, etc. were to be taken from a set of

standard active verbs
2. Objects names were to be selected from a set of standard object

names
3. Standard abbreviations for objects were to be used
4. Use of standard processes where possible
5. Maps would be reviewed by other team members during development
6. Maps should fit on one page of A4 and be readable
7. PiMS usage should be identified
8. Use of already developed “template” maps for higher level processes
9. Use of “Goto” notes to identify map linkages
10. Inclusion of process descriptions – where possible
11. Process notes should be written to capture information not readily

observed on the maps

The team evaluated several tools that could be used to develop the IDEF3
maps. The evaluation showed that ProSim 7 had several advantages over


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other possible tools to create the IDEF3 maps. The main advantages of using
ProSim 7 over other software tools were:


It is a specialised IDEF3 modelling tool



It allows the publishing of the knowledge base in html

After the maps were developed with ProSim 7, the interviewer validated the
“AS IS” model with the interviewee by walking the interviewee through the
entire captured process. This was to ensure that any omissions or corrections
were detected. These changes were then fed back into the process maps to
update the “AS IS” Model to correctly reflect the actual process.
Once all maps were validated, the team then indexed the maps for easy
referencing and created an html version of the maps to facilitate navigation
and publishing by the Trust.
In total, 32 process maps were developed and verified. An example process
map for the outpatient process of a consultant in Gynaecology is illustrated in
Figure 1.

SPR MAKES
DTA &
ASSIGNS
PRIORITY

CONS MAKES
DTA &
ASSIGNS
PRIORITY

X

X

IF PRIORITY IS
URGENT

X

X

IF PRIORITY IS
ROUTINE

CONS OFFERS
PATIENT TCI
DATE FROM
DIARY

X

SPR OFFERS
PATIENT TCI
DATE FROM
DIARY

SHO OFFERS
PATIENT TCI
DATE FROM
DIARY

Figure 1: Outpatient process for a consultant in Gynaecology


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Results & findings
Specialities
Ear, Nose and Throat
The following describes the waiting list processes for Mr Arasaratnam (Map
Number 03.0.0.0), Mr Frampton (Map Number 04.0.0.0) and Mr Hoare (Map
Number 05.0.0.0).

Admission Process
It has to be said, that everyone within the ENT speciality, works in a very
similar way. What follows is a description of the processes and information
flows that occur, highlighting any relevant differences among the three
secretaries interviewed:
The process starts at the clinic, where Consultant, Registrar, SHO or Junior
Doctor makes decision to admit, fills in the PAAF, and they assign priority to
patients as follows:


Mr Arasaratnam divides his patients into urgent, soon and routine. It is
rare that he gives a date to the patient at the clinic.



Mr Frampton divides his patients into urgent and routine and he
sometimes assigns a date to the patient at the clinic. (This happens
when it is a very urgent situation or a special occasion.)



Mr Hoare divides his patients into urgent, soon and routine and he
when it is a very urgent situation or a special occasion.)

Once the secretary has received the PAAF and patient notes at her office, she
checks them and she allocates TCI dates to the patients.
It is only Charlotte Mobbs, secretary to Mr Hoare, the one that does this
together with the consultant and, instead of putting the information into a
diary, they use an Access database that Mr Hoare created in 1997.
This TCI list, is emailed by the secretary to Admissions Department, and is at
this point when the patients are first added to the waiting list. The Admissions
Department is the one in charge of sending a letter to the patient, offering a
date for pre-op assessment and for the operation.


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The day before of the theatre session, the secretary reviews her diary,
allocates operation order, creates and emails the Theatre List to theatre staff,
doctors and wards. (Charlotte Mobbs, secretary to Mr Hoare, would review
her database and make these decisions together with the consultant) It is also
important to mention that Charlotte Mobbs is the only secretary in this
speciality that creates her Theatre list straight away on PiMS.

Hospital Cancellations
When there is a cancellation by hospital at the PAC, the secretary receives
the cancellation from the ward. She adds a reason for the cancellation into the
dairy (Charlotte Mobbs, uses her database), reallocates the theatre time and
does what is appropriate for each situation (suspend the patient or cancel the
operation because it is no longer required). In both of the previous cases, she
informs Admissions Department about it.
When there is a cancellation by hospital at the OP, the secretary receives the
cancellation from ward, consultant, Admissions Department or Theatre. She
adds a reason for the cancellation into the dairy (Charlotte Mobbs, uses her
database) and does what is appropriate for each situation. The most common
of the cancellations by hospital at the OP is the lack of beds, and in this case
she has to allocate a new date within 28 days. Mr Hoare mentioned that he
also has to cancel quite often because of the equipment, sometimes there is
no time to sterilise the equipment to be able to use it twice a day.

Patient DNAs
When there is a DNA at the pre-op assessment, the ward informs the
secretary of the DNA and then she informs Admissions Department so they
can find out the reason of the DNA. When the secretary knows the reason,
she does what appropriate for each situation.
When there is a DNA at the op, the ward or the Admissions Department
informs the secretary. Once she is informed from Admissions about the
reason of the DNA, they (consultant and secretary) decide what to do with the
patient (suspending, cancelling, allocating another date...) depending on the
case.

Patient Cancellations
When there is a cancellation by patient, the secretary receives the
cancellation from Admissions Department or directly from the patient. She
adds reason for the cancellation into the dairy (Charlotte Mobbs, uses her
database), reallocates the theatre time and does what is appropriate for each
situation - suspend the patient or cancel the operation because it is no longer


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required. In both of the previous cases, she informs Admissions Department
about it.

General Surgery and Urology
The following describes the waiting list processes for Mr Tisi (Map number
11.0.0.0).

Admission Process
Only Mr Tisi makes the decision to admit. He specifies priority as either urgent
or routine and allocates TCI dates to all patients except those who require
minor surgery in the laser clinic. Mr Tisi fills in a standard PAAF and passes
one copy to his secretary and one copy to the Admissions Department to add
the patient to his waiting list. Mr Tisi‟s secretary maintains an outlook and
physical diary and these are used to create a theatre list the day before
surgery. Mr Tisi, specifies the order that the patients will be operated upon
and then the list is emailed to the Theatre Department.

If one of Mr Tisi‟s patients is to be admitted for surgery, they attend a PreAssessment Clinic (PAC) straight after their outpatient appointment. If at the
PAC the patient is deemed unfit to attend surgery, they are asked to contact
Mr Tisi‟s secretary once they are fit and Mr Tisi is informed and does not
proceed with that patient‟s PAAF. If the patient is unfit on the day of the
operation and it is a minor problem, like a cold, Mr Tisi will allocate a new TCI
date. If the problem is more serious, Mr Tisi will remove the patient from the
waiting list and refer the patient back to their GP or may choose to see them
as an outpatient.
If a patient is cancelled due to a lack of hospital resources then they are
allocated a new TCI date.

Patient DNAs
According to his secretary, Mr Tisi does not have DNAs at either the PAC or
operation.



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In the case of a patient cancellation, Mr Tisi‟s secretary is notified either by the
patient or by the Admissions Department. She notifies Mr Tisi and if the
patient notifies the secretary directly then she informs the Admissions
Department. If the patient states that they no longer require surgery, she asks
the Admissions Department to remove the patient from the waiting list and Mr
Tisi informs the patient‟s GP of the removal via letter. If the patient states that
they are unfit for surgery, she consults with Mr Tisi and he decides whether
the patient should be removed from the waiting list or suspended. If the
patient requires suspension, Mr Tisi‟s secretary will ask the Admissions
Department to suspend the patient from the waiting list. If the patient simply
cannot attend the specified TCI date, Mr Tisi will allocate a new one and his
secretary will inform the Admissions Department. If time permits, Mr Tisi will
reallocate any free theatre time at his outpatient clinic.

Use of PiMS
Mr Tisi‟s secretary uses PiMS to check patient information and also to check
the waiting times of patients for the minor operations clinic. If these patients
wait more than 6 months, she will transfer them to Mr Tisi‟s waiting list to
ensure they are operated upon, as soon as possible.

The following describes the waiting list processes for Mr Parsons (Map
number 9.0.0.0)

Admission Process
In Mr Parsons‟ team, Mr Parsons, the Staff Grade, Registrar and SHO make
the decision to admit. They specify priority as either urgent, soon or routine
and allocates TCI dates to all patients except those who only require very
minor surgery in the laser clinic. They fill in a standard PAAF and pass one
copy to Mr Parsons‟ secretary and one copy to the Admissions Department to
add the patient to his waiting list. Mr Parsons‟ secretary maintains a physical
diary and this is used to create a theatre list the day before surgery. Mr
Parsons specifies the order that the patients will be operated upon and then
the list is emailed to the Theatre Department.

If at the PAC or on the day of operation the patient no longer requires surgery
or is unfit for an operation, they are removed from the waiting list.
If a patient is cancelled on the day of operation due to a lack of hospital
resources, they are allocated a new TCI date within 28 days.


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Patient DNAs
If a patient does not attend their PAC, Mr Parson‟s secretary will try to
establish contact with the patient. If she cannot do this, the patient is removed
from the waiting list. If she does and the patient no longer requires surgery or
is unfit for an operation, they are removed from the waiting list. If they contact
Mr Parsons‟ secretary within 48 hours and did not attend for any other reason,
Mr Parsons‟ secretary will arrange a PAC for the patient.

In the case of a patient cancellation, Mr Parson‟s secretary is notified either by
the patient or by the Admissions Department. If the patient notifies the
secretary directly, she informs the Admissions Department. If the patient
states that they no longer require surgery, she asks the Admissions
Department to remove the patient from the waiting list and informs the
patient‟s GP of the removal via letter. If the patient states that they are unfit for
surgery they are removed from the waiting list and asked to contact Mr
Parsons‟ secretary when they are fit. If the patient simply cannot attend the
specified TCI date, Mr Parsons‟ secretary will allocate a new one and inform
the Admissions Department. If time permits, Mr Parsons will reallocate any
free theatre time at his outpatient clinic.

Use of PiMS
Mr Parsons‟ secretary uses PiMS to check patient information. She also uses
the PTL to cross check her own waiting list records.

The following describes the waiting list processes for Mr Callam (Map number
6.0.0.0).

Admission Process
In Mr Callam‟s team, Mr Callam, the Staff Grade, Registrar and SHO make
the decision to admit. They specify priority as either urgent or routine. The
clinicians fill in a standard PAAF and pass it to Mr Callam‟s secretary and one
copy is sent to the Waiting List Department to add the patient to Mr Callam‟s
waiting list. Mr Callam‟s secretary maintains a physical diary and also files
PAAFs to maintain the waiting list. Mr Callam specifies TCI dates for patients
with at least two weeks notice. His secretary informs the Admissions
Department of these dates. The diary is used to create a theatre list the day
before surgery. Mr Callam specifies the order that the patients will be
operated upon and then the list is taken to the Theatre Department by the HO.


13

If at the PAC or on the day of operation the patient no longer requires an
operation, they are removed from the waiting list. If they are deemed unfit to
attend surgery then they are suspended from the waiting list.
If a theatre slot becomes available after the PAC for one of the reasons above
or if a patient does not attend, then Mr Callam‟s secretary will again try to
reallocate the theatre time.
resources then they are allocated a new TCI date and will be treated as an
urgent patient.

Patient DNAs
If a patient does not attend their PAC or operation then Mr Callam‟s secretary
will try to establish contact with the patient. If she cannot do this then the
patient is removed from the waiting list. If she does and the patient no longer
requires an operation then they are removed from the waiting list. If they are
unfit to attend surgery then they are suspended from the waiting list. If they
did not attend for any other reason then Mr Callam‟s secretary will arrange for
the patient to be seen as an outpatient.

In the case of a patient cancellation Mr Callam‟s secretary is notified by either
the patient or the Admissions Department. She notifies Mr Callam and if the
patient states that they no longer require surgery, Mr Callam informs the
patient‟s GP of the removal via letter, which is copied to the Waiting List
Department. If the patient requires suspension, Mr Callam‟s secretary will ask
the Admissions Department to suspend the patient from the waiting list. If the
patient simply cannot attend the specified TCI date, Mr Callam will allocate a
new one when allocating other TCI dates and his secretary will inform the
Admissions Department. If time permits, Mr Callam‟s secretary will reallocate
any free theatre time. If necessary, she will offer a TCI date to a patient before
informing the Admissions Department of the TCI date.

The following describes the waiting list processes for Mr Skipper (Map number
10.0.0.0)

As Mr Callam except


14



Only Mr Skipper and his Staff Grade make the decision to admit.



TCI dates are given to patients at the outpatient clinic if the waiting list
length is at a manageable level



Mr Skipper creates his own theatre list and takes it to the Theatre
Department



If a patient requires removal from the waiting list the Admissions
Department will be asked to do this and also an outpatient appointment
is arranged for the patient



Mr Skipper‟s secretary uses PiMS to check patient information.

The following describes the waiting list processes for Mr Waterfall (Map
number 22.0.0.0) (UROLOGY)

Admission Process
In Mr Waterfall‟s team, Mr Waterfall, the Staff Grade, Registrar and SHO
make the decision to admit. They specify priority as either urgent, soon or
routine. The clinicians fill in a standard PAAF and pass it to Mr Waterfall‟s
secretary and one copy is sent to the Waiting List Department to add the
patient to Mr Waterfall‟s waiting list. Mr Waterfall‟s secretary maintains a
physical diary and also creates T-cards to maintain the waiting list. Mr
Waterfall‟s secretary specifies TCI dates for patients with at least two weeks
notice. She informs the Admissions Department of these dates. The diary is
used to create a theatre list the day before surgery. Mr Waterfall specifies the
order that the patients will be operated upon and then the list is emailed to the
Theatre Department by the secretary.

operation then they are removed from the waiting list. If they are deemed unfit
to attend surgery then they are suspended from the waiting list. In both cases
the patients GP is informed via letter.
If a theatre slot becomes available after the PAC for one of the reasons above
or if a patient does not attend then Mr Waterfalls secretary will again try to
reallocate the theatre time.


15

resources then they are allocated a new TCI date and will allocated a TCI
date within 28 days.

Patient DNAs
If a patient does not attend their PAC or operation then Mr Waterfall‟s
secretary will try to establish contact with the patient. If she cannot do this
then the patient is removed from the waiting list. If she does and the patient no
longer requires an operation then they are removed from the waiting list. If
they are unfit to attend surgery then they are suspended from the waiting list.
If they did not attend for any other reason then they will be allocated a new
TCI date.

In the case of a patient cancellation, the patient or the Admissions Department
notifies Mr Waterfall‟s secretary. She notifies Mr Waterfall and if the patient
has notified her, she informs the Admissions Department. If the patient states
that they no longer require surgery, the secretary arranges them an outpatient
appointment and also asks the Admissions Department to remove the patient
from the waiting list. If the patient requires suspension, Mr Waterfall‟s
secretary will ask the Admissions Department to suspend the patient from the
waiting list. If the patient simply cannot attend the specified TCI date, the
secretary will allocate a new one when allocating other TCI dates and will
inform the Admissions Department. If time permits, Mr Waterfall‟s secretary
will reallocate any free theatre time. If necessary, she will offer a TCI date to a
patient before informing the Admissions Department of the TCI date.

Use of PiMS
Mr Waterfall‟s secretary uses PiMS to check patient information and to
confirm appointments. She uses the PTL to highlight patients who are close to
the 12-month deadline.

The following describes the waiting list processes for Mr Eldin (Map number
7.0.0.0)

As Mr Waterfall except


Only Mr Eldin and his Registrar make the decision to admit.


16



TCI dates are given to patients at the outpatient clinic if the patient‟s
priority is urgent.



Mr Eldin uses a non-standard PAAF and has urgent and 3 month
priority for endoscopies. For all other procedures urgent, early or when
convenient are the priorities specified.



The theatre list is sent to Theatre Department, Anaesthetics and
Wards.



A letter is not sent to the patients GP if a patient is suspended from the
waiting list.

The following describes the waiting list processes for Mr Foley (Map number
8.0.0.0)

Admission Process
In Mr Foley‟s team, Mr Foley, the Staff Grade, Registrar and SHO make the
decision to admit. They specify priority as either urgent, soon or routine. The
clinicians fill in a non-standard PAAF and pass it to Mr Foley‟s secretary and
one copy is sent to the Waiting List Department to add the patient to Mr
Foley‟s waiting list. Mr Foley‟s specialist nurse maintains a physical diary and
files PAAFs to maintain the waiting list. She specifies TCI dates for patients
with at least two weeks notice. She also informs the Admissions Department
of these dates. The diary is used to create a theatre list the day before
surgery. Mr Foley‟s specialist nurse specifies the order that the patients will be
operated upon and then the list is emailed to the Theatre Department,
Clinicians, Waiting List Department and Anaesthetists.

operation then they are removed from the waiting list. If they are deemed to
be unfit to attend surgery then they are suspended from the waiting list.
However if on the day of operation the patient only has a minor condition like
a cold a new TCI date will be arranged.
resources then they are allocated a new TCI date within 28 days.

Patient DNAs


17

If a patient does not attend their PAC or operation then Mr Foley‟s specialist
nurse will contact the Admissions Department.

In the case of a patient cancellation Mr Foley‟s specialist nurse is notified by
either the Admissions Department or by checking PiMS. If the patient states
that they no longer require surgery they are removed from the waiting list. If
the patient requires suspension they are suspended from the waiting list. If the
patient simply cannot attend the specified TCI date, Mr Foley‟s specialist
nurse will allocate a new one and will inform the Admissions Department. If
time permits Mr Foley‟s specialist nurse will reallocate any free theatre time.

Gynaecology
The following describes the waiting list processes for Mr Budden (Map
Number 12.0.0.0) and Mrs Wallace (Map Number 13.0.0.0).

Admission Process
During the outpatient appointment, if a patient requires further treatment, the
Consultant or his Registrar makes a DTA and assigns a clinical priority. The
Consultant, Registrar or SHO (“the clinician”) offers the patient an appropriate
TCI date from the Consultant‟s diary.
If the patient and the clinician agree on a TCI date, the clinic nurse enters the
patient details, procedure and TCI date onto the T-Card, which is received by
the Consultant‟s secretary after clinic.
If the patient and clinician are unable to agree a TCI date, the patient is invited
to call the secretary to agree a TCI date from the diary. Once a TCI date has
been agreed, the secretary adds the patient to the waiting list on PiMS with
his/her TCI date and sends a letter to the referrer.
Five days prior to TCI dates in the diary, the secretary sends patients notes
for this TCI date to the wards. The day before the next theatre for the
clinician, the secretary creates a theatre list from the diary and sends it to the
theatre secretaries and theatre Manager.

If a patient is cancelled on the day of surgery by the ward (secretary is
informed by the bed manager, ward or patient) or by the theatre (secretary


18

informed by the Consultant or theatre secretary), the secretary re-books the
patient procedure to be within 28 days of cancellation.
If a patient is cancelled at the nurse PAC, the clinic nurse informs the
secretary. The clinician offers the patient an appropriate TCI date from the
team‟s diary.
If the patient and clinician are unable to agree a TCI date, the patient is invited
to call the secretary to agree on a TCI date from the diary. Once a TCI date
has been agreed, the secretary cancels the previous TCI date and enters the
new TCI date onto PiMS.

Patient DNAs
DNAs have not occurred at a nurse PAC.
If a patient DNA the operation, the patient notes are returned from the ward to
the secretary with a DNA status. Normally, the ward‟s senior nurse or sister
calls the secretary about the DNA. The ward may also enter the DNA status
onto PiMS.
For certain DNAs (generally, day surgery procedures such as sterilisations or
terminations), the secretary does not consult with the Consultant but contacts
the referrer to inform her/him of the DNA.
If the secretary informs the Consultant, she may either contact the referrer as
above or contact the patient either to re-book the operation or to remove the
patient from the waiting list on PiMS.

If a patient wants to change his/her TCI date, the secretary offers the patient a
new TCI from the diary and enters the information onto PiMS.
If the patient does not want the procedure, the secretary may or may not
consult with the Consultant. Where the Consultant is not informed (e.g. for
sterilisations or terminations), the secretary may write the referrer before
removing the patient from waiting list.
Where the Consultant is informed, if the Consultant advises the removal of the
patient, she may contact the referrer before removing the patient from the
waiting list. Otherwise, the Consultant may request an outpatient appointment
for the patient.
For cancelled TCI dates, if time permits, the secretary attempts to replace the
cancelled TCI slot with an appropriate patient from the diary.
If a patient cancels the nurse PAC, then patient is offered a PAC on ward.


19

Ophthalmology
This following describes the waiting list processes for Mrs Pieris (Map Number
14.0.0.0).

Admission Process
Consultant, Associate Specialist, Staff Grade, Hospital Practitioner or Senior
Clinical Officer makes a DTA (“the clinician”) and assigns a clinical priority.
The clinician then fills in the PAAF. The clinic nurse sends a copy of the
PAAF to the Waiting List Department.
Using the patient‟s clinic bundle, the secretary creates a T-card and sends a
letter to the referrer. A nurse PAC date is booked for urgent patients and nonurgent patients receive a nurse PAC date once their T-card has progressed to
a free PAC date on the T-board.
After the nurse PAC, the secretary updates T-Cards and allocates TCI dates
to T-Cards given the patient‟s clinical priority and DTA date. A TCI letter from
PiMS with Dr PAC and Dr Post Assessment Clinic dates is then sent to the
patient.
The day before the next theatre session for the clinician, the secretary creates
a theatre list from the T-cards and sends it to the clinic receptionist, eye
theatre receptionist, theatre secretaries and the wards. (She also places the
list in the Dr PAC.) The clinic receptionist then enters TCI dates onto PiMS.

informed by the ward, clinic nurse, clinician or eye theatre receptionist) or by
the theatre (secretary informed by the clinic nurse, clinician or eye theatre
receptionist), the secretary allocates a new TCI date and calls the patient to
re-book. She then amends the theatre list and sends it to the normal
distribution.
If a patient is cancelled at the Doctor PAC, the clinic nurse or Clinician informs
the secretary. The secretary cancels the TCI and post assessment dates and
notifies the Waiting List Department to suspend or remove the patient as
advised by the Consultant. If the patient is removed, the referrer is notified.


20

At the same time, the secretary attempts to fill the cancelled TCI slot with a
patient – normally a “one-stop” patient. The theatre list is amended and sent
to the normal distribution.

Patient DNAs
The clinic nurse or Clinician tells the secretary of DNAs that occur at nurse
PACs. If the patient does not want to be re-booked, the Waiting List
Department is asked to remove the patient from the waiting list. If the patient
wants to re-book, the secretary allocates a new nurse PAC date as before.
The secretary then sends an appointment letter to the patient.
The clinic nurse or clinician tells the secretary of DNAs that occur at Dr PAC.
If the patient does not want to be re-booked, the Waiting List Department is
asked to remove the patient from the waiting list. If the patient wants to rebook, the secretary allocates a Dr PAC date if one is available before TCI date
or allocates new a TCI date and books Dr PAC and Post Assessment dates.
The secretary then sends an appointment letter to the patient.
If a DNA occurs on operation day, the ward, eye theatre receptionist or
clinician tells the secretary. The secretary may inform the theatre secretary
about the DNA.
The clinician may ask the secretary to find a replacement patient. In this
case, the secretary attempts to contact an appropriate patient who can come
in for surgery. This is generally a “one stop” patient and the theatre list is
amended and sent to the normal distribution.

If a patient wants to change his/her TCI date, for the first cancellation, the
secretary allocates a new TCI, Dr PAC and Post Assessment dates and
sends an appointment letter to the patient. For subsequent cancellations, the
above occurs or the secretary asks the Waiting List Department to suspend or
remove the patient. If the patient is to be removed, a letter is sent to the
referrer.
If the patient does not want the procedure, the secretary will ask the Waiting
List Department to suspend or remove the patient. If the patient is to be
removed, a letter is sent to the referrer.
cancelled TCI slot with an appropriate patient after reviewing the T-Cards. An
updated theatre list is sent to the normal distribution.


21

If a patient cancels the Dr PAC, the secretary books a Dr PAC date if one is
available before the TCI date or allocates a new TCI date and books Dr PAC
and Post Assessment dates. The secretary then sends an appointment letter
to the patient.
If a patient cancels the nurse PAC, the secretary books a new nurse PAC.
The secretary also reviews the T-Cards and books a replacement patient.

Oral Maxillo-Facial
This following describes the general waiting list processes for Consultants Mr
Simpson (Map Number 16.0.0.0) and Mr Chan (Map Number 15.0.0.0).

Admission Process
Consultant, Associate Specialist, Registrar or SHO (“the clinician”) makes a
DTA and assigns a clinical priority. If the priority is urgent, the clinician may
offer the patient an appropriate TCI date from the Consultant‟s diary. If a date
is offered, the clinician fills the General Anaesthesia Waiting List (GA W/L)
Card and the secretary or clinician adds the patient‟s details to the diary. GA
W/L Cards are then sent to the Waiting List Department.
Monthly, the secretary reviews the GA W/L Cards and this may include the
PTL to allocate TCI dates given the patient priority and DTA. The secretary
then enters these patients in the GA W/L Diary (under TCI date) and sends
the list to the Admissions Department.
One or more days before the next theatre session for the clinician, the
secretary creates a theatre list from the diary and sends it to the wards,
theatre secretaries and theatre Manager.

informed by the bed manager, ward, Admissions Department or Waiting List
Manager) or by the theatre (secretary informed by the Admissions Department
or by the clinician), the secretary allocates a new TCI date and calls the
patient to re-book. She then amends the theatre list and sends it to the
normal distribution.
If a patient is cancelled at the Doctor PAC, the clinician informs the secretary.
The secretary then asks the Admissions Department to cancel the patient‟s
TCI date, to suspend the patient or to remove the patient from the waiting list.
If the patient is to be removed, a letter is sent to the referrer.


22

Patient DNAs
For DNAs at the Dr PAC, the clinic nurse contacts the secretary who asks the
Admissions Department to validate the patient or to send a PAC appointment
to the patient if the secretary has offered the patient a PAC date.
If a patient DNA at an operation, the secretary is notified by the Consultant or
Ward. The secretary then asks the Waiting List Department to remove the
patient from the waiting list and sends a letter to the referrer indicating the
removal.

The Admissions Department or the patient contacts the secretary to cancel an
appointment.
If a patient wants to change his/her TCI date, for the first cancellation, the
secretary offers the patient a new TCI date and enters patient and operation
details into the GA diary. Admissions is sent a new TCI date for the patient.
For a second cancellation, either the patient accepts the original date or the
secretary asks the Waiting List Department to remove the patient from the
waiting list. A letter is sent to the referrer if a removal occurs.
If the patient does not want the operation, the secretary will ask the Waiting
List Department to remove the patient. If the patient is to be removed, a letter
is sent to the referrer.
cancelled TCI slot with an appropriate patient.
If a patient cancels the Doctor PAC, then a patient is offered a new PAC and
Admissions is asked to send a letter to the patient.

Trauma and Orthopaedics
The following describes the waiting list processes for Mr Rawlins (Map
Number 20.0.0.0), Mr Handley (Map Number 18.0.0.0), Mr Riley (Map
Number 21.0.0.0), Mr Nel (Map Number 19.0.0.0) and Mr Edge (Map Number
17.0.0.0).

Admission Process


23

It has to be said that everyone within the TRAUMA and ORTHOPAEDICS
speciality, works on a very similar way. Here, there is a description of the
process and flow of information, highlighting any relevant differences among
the team.
Everything starts at the clinic, where Consultant, Registrar, SHO or Junior
Doctor fill in the PAAF, and assign priority to the patients as follows:


Mr Rawlins divides his patients into urgent, soon and routine and it is
very rare that he gives a date to the patient at the clinic.



Mr Handley divides his patients into urgent, soon and routine and he
never assigns a date to the patient at the clinic.



Mr Riley divides his patients into urgent, soon and routine and he
when it is a very urgent situation or a special occasion)



Mr Nel divides his patients into very urgent, urgent, soon and routine.
Sometimes, with the very urgent ones he assigns a date at the clinic.



Mr Edge divides his patients into urgent, soon and routine. Sometimes
he assigns a date to the patient at the clinic, but this does not happens
very often.

Once the secretary has received PAAF and patient notes at her office, she
checks them, transcribes all the relevant information onto the T-Card Board
and they type and send the clinic letter to the General Practitioner. (it should
be mentioned that Anne Wright, secretary to Mr Handley, is the only secretary
that types the clinic letter straight away onto PiMS). Each of the five
secretaries we talked to in this speciality, use a T-Card board to organise their
patient‟s information. The secretary allocates TCI dates to the patients by
checking the T-Card Board.
It is only in the cases of Anne Wright and Diana Wiser, when the secretary
allocates the TCI dates to the patients on her own. The other three secretaries
do this job together with the consultant. In the case of Anne Wright, she
confirms the date that she is allocating, by telephoning the patient. By doing
this, she avoids many cancellations by patient and DNAs.
They all place the T-Cards with TCI date assigned, in the allocated date
column, and they create and email the TCI list to the Admissions Department
and anyone else required.
The day before of the theatre session, the secretary reviews her T-Card
Board, allocates operation order, creates and emails the theatre list to theatre


24

staff, doctors and wards. They all do this by their own, using their experience
and knowledge, except from Susan Reid who does this together with Mr
Rawlins, her consultant.

When there is a cancellation by hospital at the PAC, the secretary receives
the cancellation from the ward or the Admissions Department. She adds
reason for the cancellation onto the T-Card, reallocates the theatre time and
does what is appropriate for each situation. (suspend the patient or cancel
the operation because it is no longer required) In both of the previous cases,
she informs Admissions Department about it.
When there is a cancellation by hospital at the OP, the secretary receives the
cancellation from ward, consultant, Admissions Department or theatre. She
adds reason for the cancellation onto the T-Card, and does what is
appropriate for each situation. The most common of the cancellations by
hospital at the OP is the lack of beds, and in this case, she has to allocate a
new date within 28 days. Diana Wiser says that sometimes she is not
informed about the cancellation by hospital (she finds it out several days
after).

Patient DNAs
When there is a DNA at the pre-op assessment, the ward informs the
secretary of the DNA and then she informs Admissions Department so they
can find out the reason of the DNA. When the secretary knows the reason,
she does what appropriate for each situation.
When there is a DNA at the op, the ward or the Admissions Department
informs the secretary. Once she is informed from admissions about the
reason of the DNA, they (consultant and secretary) decide what to do with the
patient (suspending, cancelling, allocating another date...) depending on the
case.

When there is a cancellation by patient, the secretary receives the
cancellation from Admissions Department or directly from the patient. She
adds reason for the cancellation onto the T-Card, reallocates the theatre time
and does what is appropriate for each situation. (suspend the patient or
cancel the operation because it is no longer required) In both of the previous
cases, she informs Admissions Department about it, so they can do what is
needed.


25

Support departments
Accident and Emergency
Accident and Emergency (Map number 2.0.0.0)
A+E deal with two types of patients heralded and non-heralded. If a patient is
heralded then a specialist consultant is specified prior to the patient arriving to
A+E. If the patient is non-heralded then they will either be treated by A+E or a
specialist consultant will be specified once the A+E doctor has diagnosed the
patients condition.
After examining the patient the consultant will decide whether or not the
patient can be treated and discharged, needs to be transferred to another
consultant or whether they need to be admitted as an inpatient.
If admitted the patient may affect elective patients if a bed or theatre slot that
had been booked is used. This could result in a patient being cancelled.

Admissions Process (Map Number 23.0.0.0)
The Admissions Supervisor receives removal requests from secretaries and
patients; suspension requests from secretaries and the PAC nurse; and
cancellation requests from patients and the Bed Manager. She also
processes requests to admit patients.
A removal request results in a patient being removed from the waiting list on
PiMS. The Removal from Inpatient Waiting List Form is filled and the
secretary is informed. A suspension request results in the patient being
suspended from the waiting list on PiMS and the secretary is notified. A
cancellation request results in the TCI being cancelled on PiMS for that
patient and a confirmation of acceptance results in that acceptance being
noted on PiMS.
During the admission process, the Admissions Supervisor enters details of the
patient admittance (if required) and TCI date onto PiMS. A TCI letter from
PiMS and a pro forma are sent to the patient. After 48 days, a list of patients
who have not responded is printed and these patients are called. If a patient
is uncontactable, then the GP is contacted for the patient‟s telephone number
and address.


26

The patient is called with the number from the GP. However, if the patient is
still uncontactable, either the secretary may continue to call or she sends
another TCI Letter and Pro Forma. At any stage where the patient is
contactable, the patient is asked to indicate whether they would like to be
removed from the waiting list, suspended from the waiting list or confirmed on
the waiting list.

DNA Process
If a patient DNA‟s on the day of surgery, the ward calls the Admissions
Supervisor. The Admissions Supervisor enters a DNA status for the patient
onto PiMS and may inform the secretary about the DNA.

Bed Manager
Bed Manager (Map Number 30.0.0.0)
The bed manager receives different information from different meetings with
different people, like for instance:


Every Friday, bed manager, waiting list manager and matron day
surgery have a meeting to create the TCI list for the weekend (Monday
included) and for the following week.



Every day from Monday to Thursday, the bed manager receives from
the Admissions Department the TCI lists for the next day, and she also
shares information with them about patient‟s beds.



Every day, bed manager receives the theatre list from theatre.

With all this information and being in constant contact with wards, theatres,
consultants and any other department required, she allocates beds and
amends the theatre list, returning it to the theatre.
Bed manager is also in charge of managing the emergency beds. If she needs
to cancel any operation, she will have to contact to Leah Caleb (waiting list
manager) or Ian Campbell if there is a serious problem to discuss.
If there is a DNA at the operation, the bed manager is informed by the
relevant ward and she will inform the Admissions Department, so they can do
what is needed.


27

Critical Care
Critical Care (Map number 28.0.0.0)
The Critical Care Department is primarily for emergency patients but on
occasions will house elective patients who require a high level of care after
surgery. In this case the bed can only be provisionally booked right up until
the day of surgery. If the bed is required for an emergency patient before the
day of operation up until the morning of surgery then the elective patient‟s
consultant will be informed and the patients operation is likely to be cancelled
until a critical care bed is available.

Inpatient PAC
Inpatient PAC (Map number 26.0.0.0)
In general, all the inpatients come for their pre-assessment clinic two weeks
before the operation. Once the pre-assessment clinic is done, different things
can happen:


Patient is ok. In this case, the patient will come for the operation as
planned.



Patient is unfit. The pre-assessment clinic nurse will discuss with the
relevant doctor what needs to be done. It could be suspending the
patient, referring the patient back to the General Practitioner or
referring the patient to other specialist required.



The operation is no longer required. The pre-assessment nurse informs
the Admissions Department and the consultant‟s secretary.

Medical Records
Medical Records (Map number 31.0.0.0)
Prior to examining or operating upon a patient the doctor must have access to
the patient‟s notes so that any previous conditions that may affect the
outcome can be identified. Medical Records store and retrieve all patient
notes within the hospital.
If the patients notes can not be located then their surgery may be cancelled,
for this reason Medical Records employs „Missing‟ Clerks whose role is to
locate notes that cannot be located in the Medical Records library.


28

Outpatient Process
Outpatients (Map number 1.0.0.0)
The majority of inpatients on the waiting list feed in from the outpatient
process. The hospital receives referrals for a patient to seen as an outpatient.
These referrals come from many sources but most come from GPs. The
referral will either be for a specified consultant at the hospital or will be
addressed to „Dear Doctor‟.
If a consultant has not been specified, then the patient will be allocated to the
consultant in the required speciality with the shortest waiting list. In some
specialities the hospital has recently introduced generic codes which allow the
consultant to specified later in the outpatient process.
When the patient is examined in the outpatient appointment the consultant
may make a decision to admit the patient in which case they will be added to
that consultant‟s inpatient waiting list.
In some circumstances the patient may actually be admitted from the
outpatient process which may affect resources specified for elective
inpatients.

Reginald Hart Inpatient Ward
Reginald Hart Inpatient Ward (Map number 27.0.0.0)
Only Inpatients visit the Reginald Hart Ward for surgery. The Ward Clerk
prepares lists of patients due to come to the ward each day and their arrival is
noted on PiMS. If a patient does not attend the relevant parties (theatre etc)
will be informed.
On the day before or the day of a patients operation the patient will be seen
by a consultant and an anaesthetist prior to the operation. If for any reason
the operation has to be cancelled the relevant parties (theatre etc) will be
informed.
If the operation goes ahead the patient will recover and if there are no
problems the patient is discharged on PiMS.
If the patient is unwell and takes longer than expected to recover this may
affect hospital resources reserved for other elective inpatients.


29

Tavistock Day Case Ward
Tavistock Day Case Ward (Map number 25.0.0.0)
Patients visit the Tavistock Day Case Ward for either PACs or for day surgery.
The Ward Clerk prepares lists of patients due to come to the ward each day
and their arrival is noted on both these forms and on PiMS. If a patient does
not attend the patients consultant will be informed.
Patients coming for the Day Case pre-assessment clinic can do it in two
different ways:


They can come as “walk-in” patients. They mean by walk-in, when they
come straight from the clinic (on the same day)



They can come as ordinary patients.

In general, all the inpatients come for their pre-assessment clinic two weeks
before the operation. Once the pre-assessment clinic is done, different things
can happen:


Patient is ok. In this case, the patient will come for the operation as
planned.



Patient is unfit. The pre-assessment clinic nurse will discuss with the
relevant doctor what needs to be done. It could be suspending the
patient, referring the patient back to the General Practitioner or
referring the patient to other specialist required.



The operation is no longer required. The pre-assessment nurse informs
the Admissions Department and the consultant‟s secretary.

Once the pre-assessment is done the pre-assessment nurse and the relevant
consultant will make the appropriate decision for the relevant patient.
On the day of a patients operation the patient will be seen by a consultant and
an anaesthetist prior to the operation. If for any reason the operation has to be
cancelled the relevant parties (theatre etc) will be informed.
If the operation goes ahead the patient will recover and if there are no
problems the patient is discharged on PiMS.
If the patient is unwell and needs to be admitted as an inpatient this may
affect hospital resources reserved for elective inpatients.


30

Theatre Process
Theatre process (Map Number 29.0.0.0)
What happens at the theatre is that they receive weekly a TCI list from the
Waiting List Manager, and they receive every day the different theatre lists,
coming from each of the secretaries.
With all this information, the theatre secretary creates the day before of the
theatre session, the final theatre list and she enters all the information onto
the PiMS.
Once the final list is created, the theatre secretary sends a copy of it to the
required ward, to the bed manager, to the X-ray department and to the
pathology laboratory.
When a cancellation by patient occurs, the relevant ward or the consultant
team informs her, so she cancels onto PiMS.
When a cancellation by hospital occurs, it could be for several reasons:


Cancellation due to the operation is no longer required. In this case, the
consultant team informs the theatre secretary and she cancels onto
PiMS.



Cancellation due to a lack of resources. The theatre secretary receives
the cancellation from the ward and then she cancels onto PiMS.



Cancellation due to the patient is unfit for surgery. The ward or the
consultant team informs about the cancellation and the theatre
secretary cancels then onto PiMS.



Cancellation due to a skill-mix at the theatre. The consultant team
informs the theatre secretary so she enters the cancellation onto PiMS.



Cancellation by bed manager. Either the bed manager or the
consultant informs the theatre secretary and she enters the
cancellation onto PiMS.

Waiting List Department
Waiting List Department (Map Number 24.0.0.0)

Long Waiter Report


31

The Waiting List Supervisor receives this report daily from the IT Department
and scans it for patients approaching the current 12-month deadline.
Secretaries are then asked for TCI dates for these patients.

Waiting List Process
The Waiting List Department receives waiting list forms (PAAFs, GA Waiting
List Card, T-Cards, etc.) from outpatient clinics. Patient details are entered
onto PiMS. However, if a form has a TCI date, it is handed to the Admissions
Department. Otherwise, a day case letter is sent to the patient with a reply
slip.

Patient Validation Manual Process
The Waiting List Information Coordinator receives removal requests from
secretaries, suspension requests from secretaries and patient validation
requests from secretaries.
PiMS. If that request is from the patient, the Removal from Inpatient Waiting
List Form is filled and a copy is sent to the GP. A suspension request, results
in the patient being suspended on the waiting list on PiMS.
During patient validation (manual) process, the Waiting List Supervisor sends
a letter to the patient with a reply slip. If the patient does not reply within 14
days, the GP is contacted for the patient‟s telephone number and address. If
the telephone number is different, the secretary calls the patient. If the
number is the same, the secretary writes the patient and gives the patient 14
days to reply.
If the patient is contactable, the patient is asked to confirm whether she/he
would like to be removed, suspended or kept on the Waiting List. Otherwise,
the patient is removed from the Waiting List on PiMS.

Patient Validation Auto Process
The Waiting List Supervisor receives removal and suspension requests from
secretaries and the Waiting List Manager. The Waiting List Supervisor also
validates 8-month waiters automatically through PiMS – at least once a week.
PiMS. If that request is from an urgent patient, the Waiting List Information
Coordinator informs the Waiting List Manager. For any other priority, either
the ward is informed (if the patient has been treated) or the Waiting List
Manager is informed (if the patient has not been treated).


32

During patient validation (auto) process, the Waiting List Information
Coordinator selects the validation option from PiMS and creates the first set of
validation letters. Patients are checked to ensure that they are not on the
waiting list. Patients with urgent priorities are referred to the appropriate
secretary and patients with TCI dates are not validated.
Letters are sent and patients have 21 days to reply. If a reply is not received,
then a second validation letter option is selected from PiMS. Patients are
checked to ensure that they are not on the waiting list. Urgent patients are
referred to the appropriate secretary and patients with TCI dates are not
validated.
Letters are sent and patients have 21 days to reply. Both of the validation
letters require that the patient indicates whether she/he would like to remain
on the waiting list, to be suspended from the waiting list or to be removed. If
no reply is received during the validation process, the Waiting List Information
Coordinator removes the patient and sends a letter to the GP and the
appropriate consultant.

Waiting List Manager (Map number 32.0.0.0)
The Waiting List Manager has several roles. She fulfils a pivotal role between
the Admissions Department, Waiting List Department, Bed Manager and
Theatre Department. She is responsible for the management of the Waiting
List and Admissions Departments and therefore to ensure that the hospital
meets government targets relating to patient waiting time.
The Waiting List Manager or one of her staff meets daily with the Bed
Manager to check whether there are enough beds to house all scheduled
elective patients. If this is not the case then depending upon the gravity of the
problem an emergency bed state may be declared. If this is the case the
Waiting List Manger will attend an emergency bed meeting where potential
cancellations will be discussed and possibly the decision to cancel will be
made.
In all cases cancelling patients is avoided if possible. The Waiting List
Manager produces the monthly theatre schedule and reallocates theatre time
that may occur because of staff holiday or illness. If a patient is cancelled in
theatre the Waiting List Manager will liaise with the Theatre Department to try
to fit the patient in elsewhere. In some cases the patient may be transferred to
a private hospital to ensure that their surgery is carried out within the 12
month deadline. Also extra theatre sessions are organised occasionally to
reduce long waiting lists.


33

There are in place waiting list initiatives with several private hospitals to
reduce waiting times for problem waiting lists.


34

Discussion
Before the IDEF3 maps were analysed, the team identified a set of eight
areas that were critical to the functioning of the waiting list process at the
Trust. The waiting processes for the consultants were then analysed under
these core areas. These areas are illustrated in Figure 2.

Figure 2: Waiting list core areas for analysis

Outpatient clinic
Who makes DTA
Out of the 20 consultant processes investigated, it was found that the DTA
was made only by the consultant in one case, by the consultant or registrar in
seven cases and by the consultant, registrar or another doctor in 12 cases.
The results are illustrated in Figure 3.


35

Who makes DTA?
12

12

Consultant only
Consultant and Registrar

10

Consultant, Registrar and
Others

8

7

6

4

2

1

0

Figure 3: Who makes DTA

What priorities are assigned to patients?
The priorities assigned to patients included not only standard priorities, such
as Urgent and Routine (in 7 cases), but variations from the standard, such as
Very Urgent, Routine and Soon (in 1 case). A summary of the priorities are
found is shown in Figure 4.

Priorities Used

Urgent and Routine
Urgent, Routine and Soon
Very Urgent, Routine and Soon
Others
1
1

11
7

Figure 4: Priorities used


36

Allocation of TCI dates
When are TCI dates given?
In investigating the circumstances under which TCI dates were given, it was
determined that in 4 cases consultants always offered a patient a TCI date in
clinic; in 8 cases, patients only received a TCI date if they were urgent; in 6
cases, TCI dates were never offered in clinic and in 1 case, TCI dates were
offered if possible. The results are presented in Figure 5.

When are TCI dates given at the O/P Clinic?
8

8

All Patients
Never
Urgent Patients
When Possible
6

7

6

5

4

4

3

2

1

1

0

Figure 5: When are TCI dates given?

Is the standard PAAF used?
It was determined that the standard PAAF form was used by 14 consultants
whilst other forms (GA W/L card, T-Card, old PAAF form, etc) were used in
the 6 other cases. The results are presented in Figure 6.


37

Is standard PAAF used?

6

Yes
No

14

Figure 6: Is the standard PAAF used?

What means are used to manage patients awaiting TCI dates?
To mange the allocation of TCI dates, it was found that in 7 cases Patient
Awaiting Admittance Forms (PAAFs) were filled in a folder and accessed
when necessary; in 8 cases a T-Card board was used to process T-Cards; in
1 case a bespoke database was used; and in 4 cases, TCI dates were
provided immediately from a diary. The results are summarised in the Figure
7.
What means are used to manage patients awaiting TCI dates?
8
PAAFs filed in a folder
8

7
T-Card Board
Bespoke database

7

TCI dates allocated at
Outpatient Clinic

6

4

5

4

3

2

1

1

0

Figure 7: What means are used to mange patients awaiting TCI dates?


38

Who allocates TCI dates?
In 4 cases, patients received TCI dates from clinicians during the outpatient
appointment. In 2 cases, patients received TCI dates from the clinician after
the outpatient appointment. However, in 11 cases, the secretary or specialist
nurse allocated TCI dates to patients after the outpatient appointment. This
information is illustrated in Figure 8.

Who allocates the patients TCI dates?
11
Clinician in Outpatient clinic

11
10

Secretary or Spec Nurse post
Outpatient clinic
9
Consultant & Secretary post
Outpatient clinic

8
7

Consultant post Outpatient clinic

6
5
4

4
3

3

2

2
1
0

Figure 8: Who allocates TCI dates?

What means are used to manage patients with TCI dates?
It was found that many different means were used to manage patients who
were given TCI dates. The two most common means involved just using a
diary (9 cases) or a T-Card board (6 cases). PiMS was actually used in 2
cases and even this involved using a diary in the outpatient clinic. The results
are presented in Figure 9.


39

What means are used to manage patients with TCI dates?
9

Outlook & Physical diary
PIMS & Physical diary
9
Physical diary
8
Physical diary & T-card board
7

6

6
T-card board
Bespoke database

5

4
2

3

2

1

1

1

1

0

Figure 9: What means are used to manage patients with TCI dates?

Who enters TCI dates into PiMS?
In 17 cases, this was done by the Admissions Department; and in three
cases, the consultant secretary entered TCI dates into PiMS. Figure 10
illustrates these results.

Who enters TCI dates into PiMS

17

3

Consultants Secretary

Figure 10: Who enters TCI dates?

What other departments are informed of TCI dates?


40

In 16 cases, no other department was notified once TCI dates were assigned
to patients; in two cases, the Waiting List Manager was notified; in one case,
the Waiting List Manager, Theatre Department, wards and Anaesthetist were
informed. This is illustrated in Figure 11.

What other departments are informed of TCI dates?

20
18
16
14
12
10
8
6
4
2
0
None
Waiting List Manager, Theatre Department, Wards, Anesthetists
Theatre Department

Figure 11: What other departments are Informed of TCI dates?

What is the PTL used for?
Only 2 secretaries used the PTL principally to select long waiters to offer them
TCI dates. in 9 cases it was used to crosscheck patients to ensure, for
example, that treated patients were not reallocated a TCI date or that “lost”
patients who did not appear on waiting lists held within the consultant practice
were found. The results are presented in Figure 12.


41

What is PTL used for?
3

6

2

9

Not used
Cross checking
Produce TCI List
Unknown

Figure 12: What is the PTL used for?

Creation of theatre schedules
Who allocates theatre list order?
In 11 cases, the consultant orders the theatre list. In 2 cases, the consultant
and his secretary ordered the theatre list. In the other seven cases, the
secretary or specialist nurse ordered the theatre list. The results are
presented in Figure 13.

Who allocates theatre order?
11

Consultant
Secretary or Spec Nurse
Consultant & Secretary

12

10
7

8

6

2
4

2

0

Figure 13: Who allocates the theatre list?


42

Which departments are informed of the theatre list?
The theatre list was found to be sent to 5 different people. In most cases,
however, the theatre list was sent solely to the Theatre Department. After
that, in 6 cases, it was sent to the Theatre Department & wards; and in 4
case, the Theatre Department, wards and Anaesthetist are informed. The
results for this question are presented in Figure 14.
Which Departments are informed of theatre dates?
1
4

7

2

6

Theatre Department
Theatre Department & Wards
Theatre Department & Waiting List Manager
Theatre Department, Wards, Anesthetists
Theatre Department, Anesthetists, Waiting List Manager &
Department

Figure 14: Which departments are informed of the theatre list?

How long before the operation is the theatre list provided?
In 16 cases, the theatre list was provided the day before the operation, in 1
case, the theatre list was provided 1 or 2 days before the operation; and in 2
cases, the theatre list was provided 2 days before the operation. This is
illustrated in Figure 15.


43

How long before Operation is theatre list provided?

1 day
1-2 days
2 days
1 week

20
18
16
14
12
10
8
6
4
2
0

Figure 15: How long before operation is theatre list produce?

Managing patient cancellations
Who informs the secretary of a patient cancellation?
In 3 cases, the patient informed the secretary directly; in 16 cases, the
Admissions Department or patient informed the secretary; and in 1 case, the
Admissions Department or PiMS informed the secretary. This is presented in
Figure 16.
Who informs Secretary of Patient cancellation?
1
3

16

Admissions Department or Patient Directly
Patient Directly
From PiMS or Admissions Department

Figure 16: Who informs secretary of patient cancellation


44

If operation is not required, what steps are taken?
In most cases, the patient was removed from the waiting list. In 14 cases, the
Admissions or Waiting List Department performed the removal; in 4 additional
cases, this same scenario occurred but the patient was also offered an
outpatient appointment. In the other two cases, the secretary either removed
the patient from the waiting list or the patient received an outpatient
appointment. This is illustrated in Figure 17 below.

Patient cancellation - If operation not required what steps are taken?
14
Admissions/Waiting List Department
asked to remove patient from Waiting
List
14

List and Outpatient appointment
arranged

12

10
Secretary removes patient from Waiting
List or Outpatient appointment
arranged

8

6

4

4

2

2

0

Figure 17: If operation not requires, what steps are taken

If a patient is unfit for surgery, what steps are taken?
Predominantly, if a patient was unfit for surgery, the Admissions or Waiting
List Department was asked to suspend the patient from the waiting list. In 2
cases, the patient was cancelled and asked to phone when fit. The results
are presented in Figure 18.


45

Patient cancellation - If patient is unfit for surgery (acute) what steps are taken?
1

1
2
1

15

Admissions/Waiting List Department asked to suspend patient from
Waiting List
Admissions/Waiting List Department asked to remove patient from
Waiting List and Patient asked to phone when fit
Appointment cancelled and Patient asked to phone when fit
Appointment cancelled or Secretary suspends Patient from Waiting
List
Unknown

Figure 18: If a patient is unfit for surgery, what steps are taken?

Managing DNAs
Who informs the secretary of a DNA at the PAC?
In 3 cases, DNAs did not occur at the PAC. Where they did occur, in 14
cases, the ward or PAC clinician informed the secretary of the DNA. The
results are illustrated in Figure 19.

Who informs Secretary of DNA at PAC?
1
3

2

14

DNAs at PAC do not occur
Ward or PAC clinician
Ward or Admissions Department
Ward, PAC clinician, Waiting List Department or
from PiMS

Figure 19: Who informs the secretary of the DNA at the PAC?


46

Who contacts the patient if a DNA occurs at the PAC?
In 8 cases, the secretary contacted the patient to find out why the DNA had
occurred; in nine cases, the secretary asked the Admissions Department to
contact the patient about the DNA; in 3 cases; DNAs did not occur. This is
illustrated below in Figure 20

Who contacts Patient if DNAs PAC occurs?
9
9

DNAs at PAC do not occur
8

Secretary
8


7

6

5

4

3

3

2

1

0
No of Consultants

Figure 20: Who contacts the patient if a DNA occurs at the PAC?

Who informs the secretary of a DNA on the day of operation?
DNAs on the day of operation did not occur for four consultants but they did
occur there were up to 5 ways by which a secretary would be informed of the
DNA. In one case, the secretary was only made aware of the DNA once she
received and read the patient‟s notes. Although, in two other cases, either the
secretary received the notes or she was informed by the ward. However, in
nine cases, the secretary was informed by the ward or by the Admissions
Department. Figure 21 illustrates the results.


47

Who informs Secretary of DNA on day of operation?
1
2

4

2

1
1

9

DNAs at operation do not occur/Secretary not informed
Ward or Admissions Department
When notes received
Consultant or Admissions Department
Ward or when notes received
Ward or Consultant
Ward, Consultant or Theatre Department

Figure 21: Who informs secretary of DNA on the day of operation?

Who contacts patient if DNA occurs on the day of operation?
In 4 cases, action was not required as DNAs did not occur. In 2 cases, it was
found that the patient was not contacted. In 9 cases, however, the Admissions
Department was asked to contact the patient. The full results are presented in
Figure 22.
Who contacts patient if DNA occurs on the day of operation?
7
7
By Secretary
By Admissions Department

6

DNAs at operation do not
occur/Secretary not informed
5

By Secretary if Consultant requests
4

4

No contact

4
Unknown
3
2

2

2
1
1

0

Figure 22: Who contacts the patient if DNA occurs on the day of operation


48

Managing hospital cancellations – surgical fitness
Who informs the secretary of hospital cancellations at PAC?
It was found that in 16 cases, the Ward or clinician informed the secretary of a
hospital cancellation; in 3 cases, the PAC clinician, Admissions or Waiting List
Department informed the secretary; and in 1 case, the secretary as aware of
the hospital cancellation after having received the returned patient‟s notes.
This information is summarised in Fig 24.
Who informs Secretary of Hospital cancellation at PAC?
1
3

16

Ward or PAC clinician
PAC clinician or Admissions/Waiting List
Department
When notes received

Fig 24: Who informs the secretary of hospital cancellations at PAC?

If operation is not required, what steps are taken?
In 3 cases, this did not occur. Where this did occur, the Admissions
Department or Waiting List Department was asked to remove the patient from
the waiting list in 13 cases. In the other four cases, the Admissions
Department or Waiting List Department was asked to remove the patient from
the waiting list and an outpatient appointment was arranged. The results are
illustrated in Figure 24.


49

If operation not required what steps are taken?

List

13
14

arranged

12

Does not occur
10

8

4

6

3
4

2

0

Figure 24: If operation is not required, what steps are taken?

If patient is unfit for surgery, what steps are taken?
Primarily, the Admissions or Waiting List Department was asked to suspend
the patient from the Waiting List – this occurs in 13 cases. In two cases, the
operation was cancelled and the patient was given a new TCI date. The full
results are summarised in Figure 25.
If patient is unfit for
surgery what steps are taken?
2

1

1

2

1
13

Patient not ever added to Waiting List and asked to
contact when fit
Admissions/Waiting List Department asked to suspend
patient from Waiting List
Admissions/Waiting List Department asked to remove
patient from Waiting List and Patient asked to phone when
fit
Appointment cancelled or Secretary suspends Patient
from Waiting List
Appointment cancelled or Patient given another TCI date
Admissions/Waiting List Department asked to remove or
suspend Patient from Waiting List

Figure 25: If patient unfit for surgery, what steps are taken?

Who informs secretary of hospital cancellation on day of operation?


50

No clear reply was received for this question. Any number of persons could
inform the secretary of this cancellation. The replies, however, were grouped
and are summarised in Figure 26
Who informs Secretary of Hospital cancellation on day of operation? - No clear answer
Common answers were
12
Ward

12

Theatre Department
Bed manager
9

Clinician

10

When notes received

8

7
8

6

3
4
2

2

0
No of Consultants

Figure 26: Who informs secretary of hospital cancellation on day of operation?

If operation not required, what steps are taken?
This did not occur in 6 cases. In the remainder of the cases, the secretary
asked the Admission or Waiting List Department to remove the patient from
the waiting list. However, in only three of these cases, was the patient offered
an outpatient appointment (Figure 27).


51

If operation not required what steps are taken?
3
6

11

Does not occur

List
arranged

Figure 27: If operation not required, what steps are taken?

If a patient is unfit for surgery, what steps are taken?
In 2 cases, this did not occur. In 14 cases, the Admissions or Waiting List
Department was asked to suspend the patient from the Waiting List. In 2
cases, the patient‟s operation was cancelled and the patient was given a new
TCI date. The results are presented in Figure 28.
If patient is unfit for surgery what steps are taken?
1

2

Does not occur

2
1

Admissions/Waiting List
Department asked to remove
patient from Waiting List and
Patient asked to phone when fit
Admissions/Waiting List
Department asked to suspend
patient from Waiting List
Appointment cancelled or Patient
given another TCI date

Unknown
14

Figure 28: If patient is unfit for surgery what steps are taken?


52

Managing hospital cancellations – hospital
resources
If a patient is cancelled due to a lack of resources, who informs the
secretary?
No clear reply was received for this question. Any number of persons could
inform the secretary of this cancellation. The replies, however, were grouped
and are summarised in Figure 29.

If patient is cancelled due to a lack of hospital resources who informs Secretary

17

Ward

18

Bed manager

16

Theatre Department
Clinician

14

12

When notes received

12

10
7
8

6

6

4

4
1
2

0

Figure 29: If a patient is cancelled due to a lack a lack of resources, who
inform the secretary?

If a patient is cancelled due to a lack of resources, what steps are
taken?
In all cases, the secretary attempted to offer the patient a TCI date within 28
days of the cancellation date. This is illustrated in Figure 30.


53

If patient is cancelled due to a lack of hospital resources, what steps are taken?

20
18
16
14
12
10
8
6
4
2
0

If possible patient allocated new TCI date within 28 days

Figure 30: If a patient is cancelled due to a lack of resources, what steps are
taken?

Use of PiMS
Most specialities used PiMS only to access patient information. In fact, in eight
cases, PiMS was not used. However, it was determined that PiMS was used
not only in the Admissions Department but also in Gynaecology and
Ophthalmology to perform the Admission process. The use of PiMS in
Gynaecology mirrored how PiMS was used in the Admissions Department
since Gynaecology performed the complete admission process – adding,
cancelling and removing patients and offering pre-assessment appointments.
PiMS use in Ophthalmology, however, was limited to adding patients and
offering pre-assessment appointments with removals, suspensions or
cancellations being referred to the Admissions Department.
In general, the features used between the various specialities and
departments are summarised in Appendix A.


54

Further action
The following are suggestions for further work at Bedford Hospital NHS Trust:

Waiting list management best practice
Analysis of Consultant Waiting list management processes to identify possible
best practice and the effect that any changes might have. Information sources
such as Quantitative data, beacon trusts, guidelines and targets relevant to
this area could be examined in this study.

Centralised versus decentralised Admissions
Investigation into what tangible benefit a centralised or decentralized
Admissions Department would provide to the Trust.

Day surgery
The NHS Plan and recent advice from the Department of Health have
indicated that scope existed to perform more surgical procedures as day
surgery. An analysis could be conducted to determine if such opportunities
exist at the Trust.

Effect of ward processes on the management of
inpatient waiting lists
Interviews with more clinical and ward staff, as well as patients, to identify
other opportunities for improvement. This could involve the elicitation of
process knowledge from ward clerks, nurses and doctors about management
of discharging, PiMS updating, Outliers, Bed Blockers etc.


55

Acknowledgements
Cranfield University would like to thank the management and staff of Bedford
Hospital NHS Trust for their enthusiasm and support in making this project a
success.
Additionally, Cranfield University would like to thank the six Master Associates
for their exceptional work on this project:
Juan Eguino
Mandy Lin
Isaac Perez-Llorca
Peter Louis
Paul Nower
Oscar Zamora

References
Audit Commission. (2001). Acute Hospital Portfolio – Day Surgery (WWW
document). http://ww2.audit-commission.gov.uk/publications/pdf/daysurgery.pdf.
(accessed 20 Apr 2003).
Bailey, T. (2003). Inpatient Waiting List Policy (Draft). Bedford Hospital NHS Trust.
Bedford.
Cahill J. (1999). Basket Cases and Trolleys – Day Surgery Proposals for the
Millennium. Journal of One Day Surgery, 9(1), 11-12.
Department of Anaesthesia. (n.d.). Selection of Patients for Day Surgery. Bedford
Hospital NHS Trust. Bedford.
Department of Health. (1999). Getting Patients Treated (WWW document).
http://www.doh.gov.uk/pub/docs/doh/waitingl.pdf. (accessed 10th February 2003).
Department of Health. (2000a). NHS Plan (WWW document).
http://www.doh.gov.uk/nhsplan/nhsplan.pdf. (accessed 10th February 2003).
Department of Health. (2002b). NHS Cancer Plan (WWW document).
http://www.doh.gov.uk/cancer/pdfs/cancerplan.pdf. (accessed 10th February 2003).
Department of Health. (2001a). Priorities and Planning Framework 2002/2003
(WWW document). http://www.doh.gov.uk/planning2002-2003/index.htm#wait.
(accessed 20th April 2003).
Department of Health. (2002a). Final Performance Indicators for Acute & Specialist
Trusts (WWW document).
http://www.doh.gov.uk/performanceratings/2003/acute_list.html. (accessed 20th April
2003).
Department of Health. (2002c). Day Surgery: Operational Guide (WWW document).
http://www.doh.gov.uk/daysurgery/day-surgery.pdf. (accessed 20th April 2003).
Modernisation Agency (2002). Operating Theatre and Pre-operative Programme:
National Good Guidance on Pre-operative Assessment for Day Surgery. (WWW
document).
http://www.modern.nhs.uk/theatre/7511/8100/Final%20Preop%20guidance%2010.09
.doc. (accessed 25 April 2003)
Modernisation Agency (2003). Operating Theatre and Pre-operative Programme:
National Good Guidance on Pre-operative Assessment for Inpatient Surgery. (WWW
document).
http://www.modern.nhs.uk/theatre/7511/11434/in%20pat%20guidance%2014.3.03.do
c (accessed 25 April 2003)
McNamara, J. (2002a). Common Procedures as Day Surgery at Bedford Hospital.
Department of Anaesthesia, Bedford Hospital NHS Trust. Bedford.
McNamara, J. (2002b). Uncommon Procedures as Day Surgery at Bedford Hospital.
Department of Anaesthesia, Bedford Hospital NHS Trust. Bedford.
National Patients Access Team. (2001). Primary Targeting Lists. Modernisation
Agency. (WWW document). http://www.modern.nhsuk.org/5556/COHORTMANAGEMENT-PTLapproach-Revised1.doc. (accessed 18th
March 2003).

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