Safety Investigation Finds Major Gaps in Outpatient Booking System

Dawn O'Shea

April 29, 2021

There is a risk that inpatients will be lost to follow-up if appointments are not made at the time of discharge, says the latest national report from England's Healthcare Safety Investigation Branch (HSIB).

The report uses a reference case to demonstrate the serious consequences of unscheduled outpatient appointments.

In mid-April 2018, Pauline, 54y, was referred by her GP to a hospital gynaecology department under the 2-week wait pathway for suspected uterine cancer

She had an outpatient hysteroscopy at the end of April and a plan was made to discuss her results and ongoing care in the rapid access clinic (RAC) two weeks later. Pauline did not attend the appointment. She was discharged from the cancer pathway by the gynaecology registrar and her care was transferred back to her GP.

In mid-June, Pauline attended the emergency department (ED) with a three-week history of lower back pain. She was diagnosed with post-procedure endometritis and was admitted to hospital and discharged one week later with a plan to be followed up at the next available outpatient appointment. The appointment was not made.

In early August, Pauline was admitted to hospital via the ED with lower abdominal pain and abnormal vaginal discharge. During her stay, the consultant discussed the option of a hysterectomy, given her ongoing symptoms; Pauline declined. She was treated with antibiotics and discharged three days later with a plan to be followed up in 6-8 weeks. The appointment was not made.

Pauline attended the ED again in October. She was admitted to hospital in December 2018 where she died in February 2019.

The information gathered about the reference event was used to inform the scope of the national investigation. The investigation identified gaps in current booking processes for outpatient

Appointments and found there is limited assurance that intended follow-up appointments are booked for patients who are not on a two-week wait or 18-week RTT pathway

The HSIB makes the following recommendations:

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

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

Dr Lesley Kay, Deputy Medical Director at HSIB said: “With a national focus on the use of technology and Covid-19 expediting the use of virtual appointments, the way that outpatients are seen will inevitably change. However, whether the appointment is in person or conducted virtually, the process for booking outpatients is the same. This is why it is important that the booking process is underpinned by robust assurance.”

This article originally appeared on Univadis, part of the Medscape Professional Network.

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