Influence of a nurse practitioner on non-attendance rate for barium enema

Abstract

SUMMARYNon-attendance for barium enema investigation wastes resources, prolongs waiting times and delays diagnosis of colorectal carcinoma. In an inner-city hospital with a previous non-attendance rate of over 20% for barium enema we investigated the value of systematic personal contact with a nurse practitioner at the time of booking. We compared two groups of patients, all of whom received an explanation of the procedure from the referring clinician.Patients referred from the colorectal clinic were accompanied by the colorectal nurse practitioner to the radiology department for booking, an appointment being sent later by mail. The nurse practitioner reiterated the details of the procedure, provided supplementary information, confirmed the patient's contact details and provided a telephone number in case further information or assistance was needed. Patients referred from the gastroenterology clinic were managed as previously, making their own way to the radiology department and receiving supplementary information only on request.The patients referred from the two clinics were closely similar; however, the non-attendance rate for the intervention (colorectal) clinic was 4/157 (2.5%) compared with 17/110 (15.5%) for the comparison clinic (P50.001).A year previously the non-attendance rates in these clinics had been 23% and 20%, respectively.These results indicate that personal contact, with supplementary information, can substantially reduce the nonattendance rate for barium enema.The tendency of patients not to keep appointments applies not only to outpatient clinics but also to planned investigations. Non-attendance rates vary between regions and specialties and are sometimes as high as 34% 1 . Nonattendance is influenced by patient gender, age, length of waiting time for the appointment and deprivation 2,3 . For certain investigations, such as barium enema, nonattendance not only wastes resources but can also delay the diagnosis of malignant disease. In our inner-city hospital, anecdotal evidence suggested that the high nonattendance rate for barium enema was attributable partly to clerical errors and partly to fear of the investigation or the result. It was proposed that the introduction of personal contact combined with supplementary advice might improve rates of attendance. PATIENTS AND METHODSAs previously, all patients in whom a barium enema was requested received an explanation of the procedure by the requesting clinician. Patients from the gastroenterology clinic then took the request form directly to the radiology department. Subsequently, by mail, they received an appointment date and bowel preparation material, along with directions for its use. Patients from the colorectal clinic followed the same procedure but were accompanied from the clinic to the radiology department by the colorectal nurse practitioner. She reiterated the explanation of the procedure and of bowel preparation and provided each patient with supplementary written information. She also confirmed the patient's contact details and p...

Factors Associated With Missed and Cancelled Colonoscopy Appointments at Veterans Health Administration Facilities

“…Undoubtedly because they are the most costly cases for the system, most prior studies examining appointment behavior in outpatient endoscopy settings have focused on missed appointments, 2,8,13,14,32,33 either combining late cancellations (ie, those 24-48 hours before the appointment) with missed appointments, 14,31,34,35 excluding cancellations, 10 or not clearly specifying whether cancellations were excluded or combined with completed appointments. 8,12,33,[36][37][38][39] Although less of a concern than late cancellations and missed appointments, early cancellations can generate waste in endoscopy clinics because scheduling and triage for these cases require staff time. If early cancellation rates are high, it may indicate room for improvement in the efficiency of scheduling and triage processes.…”

Factors Contributing to Patient Nonattendance at Open-access Endoscopy

“…We believe that the main reasons for the low nonattendance rate in our OAE are the proactive scheduling system and the effective patient reminder system, which involves the routine calling of patients before their scheduled endoscopy. Telephone reminders have been found useful in improving attendance at outpatient clinics [19]. Some authors have also demonstrated that good communication between the patient and the referral physician, with a thorough explanation of the procedure, is one of the most important reasons for good attendance at outpatient clinics [20][21][22].…”

The economics of non-attendance and the expected effect of charging a fine on non-attendees

“…[9,32,[35][36][37][38][39][40][41][42][43], and giving patients information e.g. [13,[43][44][45] have significant effects on non-attendance rates. The effect of charging a fine on non-attendees has only been explored in two studies to the author's knowledge both revealing that non-attendance rate was decreased [21,46].…”