The Challenge
An orthopedic outpatient service was facing rapidly escalating demand. Urgent new patients were waiting an average of 33 days for an appointment, a delay that carried serious clinical risk for conditions such as hip dysplasia, talipes, slipped upper femoral epiphysis, and scoliosis, where early intervention directly influences outcomes.
A review of 828 patients on the waiting list revealed a compounding problem: 85 percent of referrals labeled as urgent were not clinically urgent once properly triaged, flooding the urgent queue and crowding out patients who genuinely needed expedited care.
The Approach
A multidisciplinary team used process mapping, cause and effect analysis, and stakeholder feedback to diagnose the full scope of the problem. The improvement initiative introduced:
- A standardized triage system using agreed clinical priority levels from P1 to P5, giving all referrals a consistent, evidence-based classification
- A structured waiting list model built within the CERNER system to make high-priority patients immediately visible and actionable
- Dedicated clinical time ring-fenced exclusively for urgent patients
- Scheduling practices standardized to prevent follow-up appointments from being booked beyond six weeks
- Non-consultant-led clinics introduced to expand overall capacity without proportional cost increases
The Outcome
Urgent wait times fell from 33 days to 13 days, a reduction that significantly lowered clinical risk for patients who needed care most.
The process became more reliable, roles were clearer, and the service was better positioned to meet demand fairly and efficiently.