A completed audit to reduce hospital outpatients non-attendance rates

Gatrad, A R

doi:10.1136/adc.82.1.59

Cited by 53 publications

(44 citation statements)

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“…The proportion of patients who claimed forgetfulness, 30%, is comparable to that seen in other specialties such as dermatology and paediatrics 13,14 . In addition, 8% did not attend since they felt better, and 24% returned their questionnaires but did not give a reason; in this group, perhaps, the reasons were trivial enough either to be forgotten or to be an embarrassment.…”

Section: Discussionsupporting

confidence: 51%

Why do patients not keep their appointments? Prospective study in a gastroenterology outpatient clinic

Murdock

Rodgers

Lindsay

et al. 2002

JRSM

139

107

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SUMMARYUnkept outpatient appointments are a drain on resources. In a prospective study we asked non-attenders at a gastroenterology clinic why they had missed their appointment.103 patients missed their appointment (14% of the total invited); 3 had died. The remaining 100 were asked to complete questionnaires, 68 by mail (43 returned) and 32 by telephone (30 successful); the response rate was thus 73%. 49 of the respondents were new patients, 6 of them with urgent referrals. The explanations for non-attendance by the 73 patients were: forgot to attend or to cancel (30%); no reason (26%); clerical errors (10%); felt better (8%), fearful of being seen by junior doctor (3%); inpatient in another hospital (3%); miscellaneous other (20%). 13 (27%) of the review patients had not kept one or more previous appointments. The non-attendance rates for different clinics ranged from 10% to 25% (average 14%).A substantial number of non-attenders claimed to have forgotten their appointment or to cancel it. If, as we surmise, this re¯ects apathy, no strategy to improve attendance is likely to have great impact. Since the nonattendance rate is reasonably constant, it can be taken into account when patients are booked.

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Section: Discussionsupporting

confidence: 51%

Why do patients not keep their appointments? Prospective study in a gastroenterology outpatient clinic

Murdock

Rodgers

Lindsay

et al. 2002

JRSM

139

107

View full text Add to dashboard Cite

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“…For example, in the study by Gatrad, 181 various cultural practices found among the local Asian Muslim population were identified as potentially affecting attendance patterns and, therefore, requiring accommodation within the appointment-making system, such as lunchtime Friday prayers.…”

Section: Explanations and Implications For Remindersmentioning

confidence: 99%

“…Maori non-attendance (13%) was slightly higher than the enrolled population of 11%. An audit study 181 of paediatric outpatients in a hospital in the West Midlands of England found differences in the appointment-keeping behaviour of patients by ethnicity. An original 1995 study had shown that non-attendance for clinic visits was around 33% for Europeans compared with 50% for Asian patients.…”

Section: Ethnicitymentioning

confidence: 99%

Targeting the Use of Reminders and Notifications for Uptake by Populations (TURNUP): a systematic review and evidence synthesis

McLean

Gee

Booth

et al. 2014

Health Services and Delivery Research

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BackgroundMissed appointments are an avoidable cost and a resource inefficiency that impact on the health of the patient and treatment outcomes. Health-care services are increasingly utilising reminder systems to counter these negative effects.ObjectivesThis project explores the differential effect of reminder systems for different segments of the population for improving attendance, cancellation and rescheduling of appointments.DesignThree inter-related reviews of quantitative and qualitative evidence relating to theoretical explanations for appointment behaviour (review 1), the effectiveness of different approaches to reminding patients to attend health service appointments (review 2) and factors likely to influence non-attendance (review 3).Data sourcesDatabase searches were conducted on Allied and Complementary Medicine, Cumulative Index to Nursing and Allied Health Literature Plus with Full Text, The Cochrane Library, EMBASE (via NHS Evidence from 1 January 2000 to January/February 2012), Health Management Information Consortium database, Institute of Electrical and Electronics EngineersXplore, The King’s Fund Library Catalogue, Maternity and Infant Care, MEDLINE, Physiotherapy Evidence Database, PsycINFO, SPORTDiscus and Web of Science from 1 January 2000 to January/February 2012. Supplementary screening of references of included studies was conducted to identify additional potentially relevant studies. Conceptual papers were identified for review 1, randomised controlled trials (RCTs) and systematic reviews for review 2 and a range of quantitative and qualitative research designs for review 3.MethodsWe conducted three inter-related reviews of quantitative and qualitative evidence, involving a review of conceptual frameworks of reminder systems and adherence behaviours, a review of the reminder effectiveness literature and a review informed by realist principles to explain the contexts and mechanisms that explain reminder effectiveness. A preliminary conceptual framework was developed to show how reminder systems work, for whom they work and in which circumstances. Six themes emerged that potentially influence the effectiveness of the reminder or whether or not patients would attend their appointment, namely the reminder–patient interaction, reminder accessibility, health-care settings, wider social issues, cancellation and rebookings, and distal/proxy attributes. Standardised review methods were used to investigate the effectiveness of reminders to promote attendance, cancellation or rebooking across all outpatient settings. Finally, a review informed by realist principles was undertaken, using the conceptual framework to explain the context and mechanisms that influence how reminders support attendance, cancellation and rebooking.ResultsA total of 466 papers relating to 463 studies were identified for reviews 2 and 3. Findings from 31 RCTs and 11 separate systematic reviews (review 2 only) revealed that reminder systems are consistently effective at reducing non-attendance at appointments, regardless of health-care setting or patient subgroups. Simple reminders that provide details of timing and location of appointments are effective for increasing attendance at appointments. Reminders that provide additional information over and above the date, time and location of the appointment (‘reminder plus’) may be more effective than simple reminders at reducing non-attendance and may be particularly useful for first appointments and screening appointments; simple reminders may be appropriate thereafter for most patients the majority of the time. There was strong evidence that the timing of reminders, between 1 and 7 days prior to the appointment, has no effect on attendance; substantial numbers of patients do not receive their reminder; reminders promote cancellation of appointments; inadequate structural factors prevent patients from cancelling appointments; and few studies investigated factors that influence the effectiveness of reminder systems for population subgroups.LimitationsGenerally speaking, the systematic review method seeks to provide a precise answer to a tightly focused question, for which there is a high degree of homogeneity within the studies. A wide range of population types, intervention, comparison and outcomes is included within the RCTs we identified. However, use of this wider approach offers greater analytical capability in terms of understanding contextual and mechanistic factors that would not have been evident in a more narrowly focused review and increases confidence that the findings will have relevance in a wide range of service settings.ConclusionsSimple reminders or ‘reminder plus’ should be sent to all patients in the absence of any clear contraindication. Other reminder alternatives may be relevant for key groups of patients: those from a deprived background, ethnic minorities, substance abusers and those with comorbidities and/or illnesses. We are developing a practice guideline that may help managers to further tailor their reminder systems for their service and client groups. We recommend future research activities in three main areas. First, more studies should routinely consider the potential for differential effects of reminder systems between patient groups in order to identify any inequalities and remedies. Second, ‘reminder plus’ systems appear promising, but there is a need for further research to understand how they influence attendance behaviour. Third, further research is required to identify strategies to ‘optimise’ reminder systems and compare performance with current approaches.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…A variety of interventions have been tried, although none has been consistently effective. 7,13 The most popular 2,6,9,10,13,17,18 This literature in the area of appointment keeping does not explain why patients do not telephone to cancel appointments, why patients cancel appointments they made only a few hours earlier, or what causes the portion of no-shows that are unaffected by interventions. The current study resulted from a decision to try to reduce the number of missed appointments at one academic family medicine clinic.…”

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confidence: 99%

Why We Don't Come: Patient Perceptions on No-Shows

Lacy

Paulman

Reuter

et al. 2004

The Annals of Family Medicine

336

277

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PURPOSE Patients who schedule clinic appointments and fail to keep them have a negative impact on the workfl ow of a clinic in many ways. This study was conducted to identify the reasons patients in an urban family practice setting give for not keeping scheduled appointments.METHODS Semistructured interviews were conducted with 34 adult patients coming to the clinic for outpatient care. Interviews were audiotaped and transcribed verbatim. A multidisciplinary team used an immersion-crystallization organizing style to analyze the content of the qualitative interviews individually and in team meetings.RESULTS Participants identifi ed 3 types of issues related to missing appointments without notifying the clinic staff: emotions, perceived disrespect, and not understanding the scheduling system. Although they discussed logistical issues of appointment keeping, participants did not identify these issues as key reasons for nonattendance. Appointment making among these participants was driven by immediate symptoms and a desire for self-care. At the same time, many of these participants experienced anticipatory fear and anxiety about both procedures and bad news. Participants did not feel obligated to keep a scheduled appointment in part because they felt disrespected by the health care system. The effect of this feeling was compounded by participants' lack of understanding of the scheduling system. CONCLUSIONSThe results of this study suggest that reducing no-show rates among patients who sometimes attend might be addressed by reviewing waiting times and participants' perspectives of personal respect. INTRODUCTIONP atients who schedule clinic appointments and fail to keep them have a negative impact on patient care, productivity, and learning opportunities. [1][2][3][4] The fi nancial impact is not relieved by same-day appointments.1 The size of the problem varies, 3,5,6 but an average of 42% of appointments become no-shows. 7Previous research indicates patients who miss appointments tend to be younger 2,[8][9][10][11] and of lower socioeconomic status. 2,11 They often have a history of failed appointments, 2 government-provided health benefi ts, 9,10 and psychosocial problems. 12 They are also less likely to understand the purpose of the appointment.8 No-show rates increase with increasing time between scheduling and the actual appointment. 3,10,11,13 Longer waiting times have been shown to be related to lower satisfaction, 14,15 which, in turn, leads to less reliable appointment keeping. 16In addition to forgetting appointments, 11,12 patients have provided several reasons for no-shows. Logistical issues include trouble getting off work, 8,11 child care, 11 transportation, 8,12,13 and cost. 2,5,13 In addition, both patients who felt better 2,8,12 and patients who felt too unwell to come 2,8,12 failed to show. A variety of interventions have been tried, although none has been consistently effective. 7,13 The most popular 2,6,9,10,13,17,18 This literature in the area of appointment keeping does not explain ...

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A completed audit to reduce hospital outpatients non-attendance rates

Cited by 53 publications

References 1 publication

Why do patients not keep their appointments? Prospective study in a gastroenterology outpatient clinic

Why do patients not keep their appointments? Prospective study in a gastroenterology outpatient clinic

Targeting the Use of Reminders and Notifications for Uptake by Populations (TURNUP): a systematic review and evidence synthesis

Why We Don't Come: Patient Perceptions on No-Shows

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