Time For Action

Here’s a follow-up to my recent post  ‘Did Not Attend‘ and the comments it generated. A new study has found there is a high rate of non-attendance by patients at hospital appointments and these ‘no-shows’ are placing a significant drain on time and resources. Now, there’s a surprise!


PATIENTS WHO do not attend their hospital appointments are a serious drain on time and resources, according to studies conducted by the medical profession.

Figures produced for two of Dublin’s biggest hospitals show that almost 25,000 did not attend appointments at St James’s Hospital last year and and the figure for St Vincent’s Hospital was almost 27,000.

A report in Britain estimates that those who do not attend (known as DNAs), cost the NHS almost €1 billion a year. No equivalent figures are available here, but the most comprehensive study carried out in the Republic to date, by Beaumont Hospital’s dermatology department, has indicated the extent of the problem.

More than one-third (36.5 per cent) of all patients did not attend their appointments in January and February last year, according to research carried out by consultant dermatologist Dr Gillian Murphy and by student doctors Hafsah Sazli and Sheena Gendeh.

An examination of other departments in the hospital indicate that the DNA rate at the dermatology department was not exceptionally high. “My students looked to see if it was disease specific and it wasn’t,” said Dr Murphy.

According to the research, 26 per cent gave not receiving their appointments as the most common reason why they did not attend. A further 22 per cent forgot their appointments, 17 per cent gave medical reasons such as a cold or diarrhoea and 12 per cent claimed they had cancelled but their names had not been taken off the list.

Other factors were wrong addresses, patient cancellations, a mistaken appointment date and work commitments. Emergencies such as a family bereavement, a broken down car or a cancelled babysitter accounted for only about 3 per cent of DNAs.

Appointments are more frequently broken by the elderly, mostly above 80 years of age, and patients with a record of previously broken appointments are more inclined to be serial absentees.

Dr Murphy said DNAs were not only a waste of hospital time, but also increased the burden on GPs whose workload was automatically doubled if they had to re-refer a patient for a hospital appointment.

Beaumont Hospital estimates that there are an average of 13-16 DNAs at the dermatology department alone on every day the clinic opens. It takes one-two hours a day to deal with the non- attendee administration.

“For all the additional work that is done in processing that information about those people, you could actually employ another secretary,” Dr Murphy said.

Luckily, modern technology offers two obvious and very cost-efficient solutions. Text messaging has been used with some success in the UK and e-mail could also be used as a back up.

Trials of a system called Managed Appointment Reminder Service (MARS) sends out a text message reminder to all patients’ nominated mobile phone at an agreed date ahead of the appointment. It has proved to be extremely successful in bringing down rates of DNAs.

Not only is it beneficial to the patient, but it also cuts down enormously on administration costs if a reply service can be updated automatically. Getting through to the relevant department can be a major problem for patients wishing to cancel.

The fundamental problem with text message, however, is that elderly people, who are more likely to miss appointments, tend not to use it.

However, Beaumont is examining if it would be possible for an elderly person to give the mobile phone number of a relative who then calls to remind that person of their appointment. Not only does it ensure that more appointments are kept, it facilitates cancellation of appointments by people who cannot keep their appointment. This in turn allows those appointments to be reallocated to others awaiting appointments.

Dr Murphy said more research needed to be done to ascertain why less than half of all patients receive their appointments in the first place, a figure which the hospital has found to be very puzzling.

However, she also said that patients must take responsibility for their own treatment and especially the nearly third of all patients who forget about their appointments or claim that they have cancelled but there is no record of such a cancellation.

“If people were more careful about their appointments, took them more seriously and were given a timely reminder closer to the date, the situation would improve.”

Source: The Irish Times Healthplus

It seems that The Biopsy Report and it’s merry band of commenters are a way ahead of the posse. We didn’t need the results of any study to know how to tackle the serious drain on hospital resources. Our health service is awash with reports that have never been acted upon. We don’t need any more reports, we need action!

6 Responses to Time For Action

  1. Baino says:

    Steph are you talking public hosptals? If so, why on earth would people miss a free appointment. It doesn’t make sense. Then in the next breath complain about the state of the HSE . . .I can understand the elderley having problems perhaps getting there or forgetting but everyone else? Very odd.

  2. Steph says:

    Baino – Hi! Yes, we are talking about public hospitals here. I suspect (from my own experience of public hospitals) that patients are often asked to return for review when it’s not strictly required. The patients don’t argue in case the appointment is needed but when the time comes and they’re feeling well, they simply don’t bother turning up. There is a huge amount of time wastage in the public system and as I’ve said before, anything that is for free is open to abuse. It’s a very different story in private health care where time is money.

    As regards the elderly not turning up, I think that is understandable in the circumstances. They are the very people who should receive a reminder phone call a few days beforehand.

  3. Baino says:

    Hmmm . interesting. I’m not sure what happens here but I know in my own area ‘Community Health’ ferry elderly people to hospital and doctor’s appointments. Still think it’s mad if you’ve got the opp for a free consult, you don’t turn up.

  4. Steph says:

    Baino – After one of my stays in a public hospital, I was handed three separate out-patient appointments on discharge, for three different clinics. This meant three trips back to the hospital, queueing for hours on each occasion. The check-ups seemed to be more a training exercise for junior docs than anything else (no sign of consultants) and were of little or no benefit to me. Is it any wonder that patients decide not to bother attending hospital appointments. Mind you, that doesn’t excuse people not phoning to cancel their appointment.

  5. Annb says:

    I had two beauties yesterday. First in an orthotic clinic in Enable Ireland, (where else?)run by an outside contractor. They checked Rory’s shoes, gave some advice and tried to send me on my way. Confused, I said we’re not here for his feet we’re here for his wrists! Needless to say, there was no wrist referral from Enable Ireland, even though I had been told by the OT secretary to turn up to be measured for wrist supports! So maybe a text reminder might be way too much to ask when you’re dealing with this level of miss-communication! The second was with a paediatrician, after waiting for an hour we had almost exactly the same consultation we had last November. If I had known in advance that it was going to be such a waste of time I would have happily joined the DNA brigade!

  6. Steph says:

    Ann – When the day comes that an appointment actually happens on time and achieves something useful, I think you’ll pass out from the shock of it!

    I know exactly what you mean about having the same consultation all over again – so frustrating! At this stage, I’ve given up politely waiting to be asked the right questions at appointments and often end up progressing the consultation myself. My consultant referred the other day to the battle I had with MRSA, in a way that implied I’d probably forgotten all about it. I gave him such a cynical look in response that he moved the discussion swiftly on!

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