Working closely with Endoscopy means we get plenty of insights into targets and approaches for improvement – at key decision stages, helping to monitor impacts during trials and even in sharing results and best practice with other units. Currently one of the key focus points in Endoscopy units is to ‘reduce the net number of lost slots’ which lines up with the National targets to achieve at least 10 points per list and take steps to tackle the rising waiting lists. 

There are a variety of approaches that could be used to make sure that lists are used to their full potential, these could include changes to the processes in the patient pathway that lead to the point they reach the hospital such as the booking and reminders processes. Another (and the focus of this piece) is to apply a practice of overbooking to fill the slots caused by cancellations. 

Using overbooking as an approach is definitely not a one-size-fits-all solution. It’s often inappropriate based on unit size and can also be dependent on the demographics of those who are required to attend a particular hospital and how that affects attendance rates as a whole. Overbooking is unlikely to be  a valid approach at units who rarely have cancelled appointments but it could be a valuable opportunity for units facing cancellation problems – to fill otherwise lost  slots that will contribute to the reduction of the overall waiting lists that the NHS faces. 

Key Data Points for Optimising Overbooking

When speaking with units who either already work with an overbooking process, or are considering a trial, there are some clear considerations that THRIVE data can help clearly display.

These include:

• Number of cancellations each day/week currently
• Reasons for cancellations & types of procedures most commonly cancelled
• Trends in day of the week or time of day with historic cancellations
• Number of rooms available and list types assigned to them
• Types of procedures that can be offered overbooked slots
  • Short procedures with minimal preparation required

All of this may be considered and affect the booking team’s decisions when finding options for short notice invited procedures. 

Managing Expectations with Overbooking

It is important to make sure that the person offered an overbooked procedure is completely aware that they are not assigned a specific time on the day of their appointment but that they will be seen as soon as there is a slot and definitely within that morning or afternoon (as appropriate). They may need to wait a little longer for their slot than a standard booked procedure but they will definitely be seen that day.

If all the criteria are met for an overbooking trial to take place then it is advisable to approach with the ability to clearly track all procedures that are completed as an Overbooked procedure so that additional metrics can be analysed such as comparing the difference between turnaround times on lists with the extra procedures in them compared to lists that proceeded ‘as normal’ or analysing the start times for the overbooked procedure to see where they end up taking place within lists. 

With no desire to make lists overrun, hospitals could aim to fit an overbooked patient in as soon as possible – in some cases this may mean a change in behaviour around ‘late arrivals’; whereas there may be an established pattern to ‘wait 15 minutes just in case they are running late’ when a confirmed attendee hasn’t arrived before their scheduled appointment – it could be better to immediately start an overbooked procedure in their absence and either they do arrive during that time and have to wait an extra 10-15 minutes until the short overbooked ODG (for example) is completed or they don’t turn up at all. Either way the room and list is being used more efficiently. 

Starting on time will also make a huge difference to a unit’s ability to add extra capacity to every list – if time is made up at the very start of the day there is more flexibility to add in additional procedures. We have written previously about the impact of late starts and how tracking reasons for late starts and the exact times that lists begin can have an insightful impact on achieving more points too. 

Overbooking as a Targeted Solution for Increasing Capacity

If a unit only averages a few cancellations per week then this may not be an appropriate option; there is no one-size fits all approach or solution to maximising procedures undertaken. In situations like this other productivity methods such as identifying underutilised lists may be more effective. This is another reason having oversight of the data, day-in day-out, is so vital to understanding opportunities and deciding which approach will make sense for each particular unit. 

With a constant target to achieve as many procedures as possible with the allotted time, space and staff; approaches such as overbooking might be a valuable addition to Endoscopy departments. 

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