Booked model: radiological performance and the role of the General Practitioner in Friuli-Venezia Giulia

Waiting lists are a structural challenge for healthcare systems, affecting equity of access, diagnostic timeliness, and perceived quality of care. The Italian National Plan for the Governance of Waiting Lists (PNGLA) 2019-2021 promoted a shift from a performance model based on delivered services to one based on booked services, in order to better capture the gap between demand and supply. In this framework, the General Practitioner (GP) is involved not only in prescribing, but also in managing patient expectations. The aim of this study was to assess the impact of this transition on radiology performance and to discuss its possible implications for GPs in Friuli-Venezia Giulia (FVG).

We conducted a retrospective observational study on Computed Tomography (CT) bookings and delivered examinations recorded in FVG between January 1 and June 30, 2025. Data were extracted from regional information systems by integrating booking data from the Central Booking System (CUP) with RIS/PACS data. The study population was stratified into oncological and non-oncological patients and by priority class (U, B, D, P). The main indicators were the gap between booked and delivered services, mean waiting times, and the proportion of examinations performed within the maximum time limits.

During the study period, 20,780 CT bookings and 19,440 delivered examinations were recorded, corresponding to an overall gap of 6.4%. This gap was higher for non-oncological patients in classes D and P (10.9% and 11.8%, respectively) compared to oncological patients (3.8% and 4.5%, respectively). The average waiting times for non-oncological patients were 37 days for class D and 92 days for class P, exceeding regional limits in 17.6% of cases. The booked/delivered gap rate (6.4%) includes no-shows, cancellations, and rescheduling. For GPs, there was a reduction in bureaucratic workload linked to oncological specialist follow-ups, but an increase in relational pressure to manage the waiting times of chronic non-oncological patients.

The booked model provides a more realistic representation of healthcare demand than the delivered model and makes inequalities between guaranteed and non-guaranteed pathways more visible. To translate this transparency into organizational improvement, dynamic scheduling tools, integrated information systems, and more structured GP involvement in planning and monitoring are needed.