Centralized Scheduling System

• Centralized scheduling system streamlines referrals and scheduling across hospitals and departments.

Integrated EHR

• System should interface with EHRs from facilities to make patient information, diagnostic results, and referral notes available on a central platform.

Unified Waitlist Management

• Elective cases are registered on a single, centralized waitlist, which enables:
• Real-time tracking with continuous updates on waiting times, appointment status, and scheduling changes.
• Prioritization algorithms with automated prioritization based on clinical urgency and other criteria.
• Transparency features such as a dashboard displaying waitlist metrics and KPIs for administrators.

Scheduling Workflow

• Typical workflow includes:
• Referral submission: Primary or secondary care providers submit referrals electronically.
• Initial triage: A dedicated triage team reviews referrals for clinical and social urgency.
• Scoring & Prioritization: Cases are assigned scores to determine priority.
• Appointment allocation: The system assigns dates based on availability, urgency, location, and the patient's preference when possible.
• Notifications and Reminders: Automated notifications are sent to patients/providers regarding upcoming appointments or changes.

Analytics and Reporting

• System generates periodic reports that includes:
• Average waiting times.
• Number of cases by urgency level.
• Geographic distribution of cases.
• Trends in waitlist dynamics over time.

Patient Portal

• Web-based portal allows patients to check their status, update information, and receive educational materials.

Stratifying Elective Cases

• An equitable approach to stratification considers clinical factors, social determinants, wait duration, and geographic factors.
• Sample stratification criteria and scoring is provided

Stratification Criteria and Scoring

• Clinical Urgency: Severity of condition that requires timely intervention is scored from 0 (low) to 2 (high).
• Potential Benefit from Timely Intervention: Likelihood of improved outcome if intervention occurs sooner is scored from 0 (marginal) to 2 (significant).
• Risk of Deterioration While Waiting: Likelihood that the patient's condition will worsen significantly is scored from 0 (unlikely) to 2 (high).
• Social Situation: Assessment of socioeconomic status and support systems scored from 0 (stable/insured) to 2 (severely poor/no support).
• Duration on Waitlist (Other Hospitals): Time already spent waiting in another facility scored from 0 (<1 month) to 2 (>3 months).
• Geographic Location: Accessibility and regional availability of services are scored from 0 (region with ample capacity) to 2 (underserved region).

Implementation of the Scorecard

• Scoring process
• At referral, the clinical team collects data for each criterion.
• Each category is scored based on pre-determined thresholds.
• Total is calculated (maximum of 12 points if six criteria score up to 2 points).
• Decision thresholds
• A pre-defined score of 7 or above may indicate a high priority for scheduling.
• Lower scores might be scheduled with a longer waiting period unless clinical circumstances change.

Regular Review and Adjustments

• Regular meetings should be held to review cases, adjust scores, and incorporate provider input.
• Monitor outcomes and wait times to ensure the scorecard remains effective and fair, and adjust thresholds.

Equity Focus

• Regularly analyze data by social and geographic stratifiers to prevent disproportionately disadvantaged groups.
• Include social workers or patient advocates in the scheduling process to address non-clinical factors that could affect timely care.

Final Considerations

• Centralized scheduling with a robust stratification checklist or scorecard ensures systematic, equitable, and transparent management of elective cases.
• It helps prioritize care based on factors such as clinical urgency, risk, social determinants, wait duration, and regional disparities, improving patient outcomes/resource allocation of healthcare resources.
• This framework is adaptable to specific systems, with ongoing evaluation and refinements.