McLeod Hugh, Ham Chris, Kipping Ruth
Health Services Management Centre, University of Birmingham, Birmingham B15 2RT.
BMJ. 2003 Nov 15;327(7424):1147. doi: 10.1136/bmj.327.7424.1147.
NHS patients requiring elective surgery usually have to wait before being treated and are usually told when a date becomes available.
18 month pilot programme to enable day case patients to book date of hospital admission at time of decision to operate.
24 pilot sites in England with relatively short waiting times and some experience of booking appointments.
Proportion of patients with booked or "to come in" date during and after pilot programme, proportion not attending for admission, and proportion waiting > or = 6 months. Comparison of pilot sites with non-pilot sites.
National Patients' Access Team established to help pilot sites enable patients to book admission dates. Provision of 9.9m pounds sterling to pilot sites to employ project managers, purchase equipment, buy extra time from clinical and other staff, and invest in information and communications technology.
Proportion of patients with booked or "to come in" date increased from 51.1% to 72.7% between end of March 1999 and end of March 2000, and then fell to 66.2% by end of March 2001. Over the same periods, the proportion of patients waiting > or = 6 months fell from 10.9% to 10.5% and then increased to 11.9%. The proportion of patients failing to attend fell from 5.7% to 3.1% between the first quarter of 1999 and the first quarter of 2000, and then increased to 4.0% in the first quarter of 2001. Pilot sites varied widely in performance during and after the pilot phase. Pilot sites had higher proportions of patients with booked or "to come in" date than non-pilot sites at end of each period.
Increasing the proportion of patients who book their date of hospital admission is possible, but there are difficulties in sustaining this. Several factors facilitated or hindered the implementation of booking, and the roll out of the programme across the NHS is seeking to incorporate these factors.
需要择期手术的英国国家医疗服务体系（NHS）患者通常要等待一段时间才能接受治疗，并且通常会被告知何时有可用日期。
为期18个月的试点项目，使日间手术患者能够在决定手术时预订住院日期。
英格兰的24个试点地点，等待时间相对较短且有一定的预约经验。
试点项目期间及之后已预订或“即将入院”日期的患者比例、未入院患者比例以及等待时间≥6个月的患者比例。将试点地点与非试点地点进行比较。
成立国家患者准入团队，以帮助试点地点让患者能够预订入院日期。向试点地点提供990万英镑，用于聘请项目经理、购买设备、从临床及其他工作人员处购买额外时间，以及投资信息和通信技术。
在1999年3月底至2000年3月底期间，已预订或“即将入院”日期的患者比例从51.1%增至72.7%，到2001年3月底又降至66.2%。在同一时期，等待时间≥6个月的患者比例从10.9%降至10.5%，然后又增至11.9%。未入院患者比例在1999年第一季度至2000年第一季度期间从5.7%降至3.1%，在2001年第一季度又增至4.0%。试点阶段期间及之后，各试点地点的表现差异很大。在每个时期结束时，试点地点已预订或“即将入院”日期的患者比例均高于非试点地点。
提高预订住院日期的患者比例是可行的，但要维持这一比例存在困难。有几个因素促进或阻碍了预订的实施，该项目在英国国家医疗服务体系中的推广正力求纳入这些因素。
