Admissions from surgical waiting lists.

Many factors tend to reduce the efficiency of bed utilization in general hospitals. A numerically small, but clinically well-recognized, cause of wastage arises from the failure of waiting list patients to attend for admission when offered beds. The relative severity of the problem varies between clinical specialties, according to the proportions of total admissions accounted for by waiting list patients. In general medicine, such wastage is small, waiting list admissions being only about 16% of total admissions (Ministry of Health and General Register Office, 1963); in general surgery, gynaecology, and E.N.T. surgery, however, the corresponding proportions are of the order of 45 %, 62 %, and 84 %, respectively, so that the problem is potentially more serious. In a study involving two London hospitals, the reasons given by patients who failed to attend for admission were investigated (Croome, Ingram, and Qvist, 1964). Of 7,119 patients sent for, 1,630 (22.9 %) failed to attend; and of the 1,630, 63% gave reasons which Croome et al. considered to be 'irresponsible'. In a more limited study at Mansfield, Ward-McQuaid (1964) reported a non-arrival rate of 25% among general surgical patients. However, in a subsequent study of male patients undergoing repair of inguinal hernia in the Mansfield hospitals (Morris, Ward, and Handyside, 1968), the nonarrival rate encountered was less than 11 %. This apparently striking difference in behaviour between two groups drawn from the same population prompted further study of waiting list patients in this area. METHOD