Quality Improvement Reports

Booking patients for hospital admissions: evaluation of a pilot programme for day cases

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7424.1147 (Published 13 November 2003) Cite this as: BMJ 2003;327:1147
  1. Hugh McLeod, research fellow (h.s.t.mcleod{at}bham.ac.uk)1,
  2. Chris Ham, professor of health policy and management1,
  3. Ruth Kipping, visiting research fellow1
  1. 1Health Services Management Centre, University of Birmingham, Birmingham B15 2RT
  1. Correspondence to: H McLeod
  • Accepted 29 July 2003


Abstract Problem NHS patients requiring elective surgery usually have to wait before being treated and are usually told when a date becomes available.

Design 18 month pilot programme to enable day case patients to book date of hospital admission at time of decision to operate.

Background and setting 24 pilot sites in England with relatively short waiting times and some experience of booking appointments.

Key measures for improvement Proportion of patients with booked or “to come in” date during and after pilot programme, proportion not attending for admission, and proportion waiting ≥ 6 months. Comparison of pilot sites with non-pilot sites.

Strategies for change National Patients' Access Team established to help pilot sites enable patients to book admission dates. Provision of £9.9m to pilot sites to employ project managers, purchase equipment, buy extra time from clinical and other staff, and invest in information and communications technology.

Effects of change 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 ≥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.

Lessons learnt 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.


  • Contributors HMcL participated in the design of the quantitative analysis, collected and analysed the quantitative data, and collected and analysed the data from the survey of project managers. HMcL, CH, and RK jointly wrote the paper. CH led the evaluation. CH, RK, and Philip Meredith collected and analysed the qualitative data. John Yates and James Raftery provided advice on the design of the quantitative analysis. HMcL and CH are guarantors for the study.

  • Funding Department of Health. The views expressed in this paper are those of the authors and are not necessarily those of the funders.

  • Competing interests CH is currently seconded to the Department of Health, where his work includes involvement in developing policy on waiting, booking, and choice.

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