Time For Action

April 1, 2009

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!

take-a-number

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!


Did Not Attend

March 30, 2009

I recently wrote a post about ways to save our health service. One of the issues I spoke about was the problem of patients not turning up for out-patient appointments. I proposed that the high DNA (did not attend) figures in our hospitals were due to a lack of respect for our inefficient health service. The first comment I received in response suggested that the problem was most likely caused by patients not receiving notification of their appointments in time. I now have reason to believe that Ian is absolutely right.

patient-centered-care

It’s been 5 weeks since I last had an out-patient appointment with my surgeon. I was advised and given a prescription lasting two months. This new treatment failed within a couple of weeks so I was seen by my GP. He mentioned that he’d had a letter from the hospital detailing my treatment and saying that I would be reviewed again in 3 weeks. This was the first I’d heard about any review appointment so I joked with my GP that it was only the stuff of routine dictation and meant nothing. However when I became ill again 10 days later, my GP decided to phone the hospital himself to see if he could get an appointment. He was told that my name was already on the list for the next out-patient clinic in two weeks time (the surgeon was away in the interim) and that I would be notified by post. Again we laughed at the absurdity of a system that forgets to inform the patient.

I’ve still heard nothing and as the appointment is scheduled for tomorrow, I phoned the hospital today to query the appointment. It was confirmed that I was on the list for the morning but no explanation could be given as to why I’d not been notified. The fact is that had I not become ill since I last attended the hospital, I would never have known that an appointment had been made for my return. Through no fault of my own, I would have been registered tomorrow as a ‘DNA’  and my appointment which could have benefited another patient, would have been wasted.

Our health service is being bled to death by administration costs and it seems that patients no longer matter. What ever happened to the concept of patient-centred care?


Save our Health Service

March 4, 2009

A letter to the editor of the Irish Times, caught my attention the other day as it’s topic was the health service. I was very pleased to find that it’s content confirmed my views about the abuse of out-patient clinic appointments in our public hospitals. The contributor proposed some ideas to solve this problem, measures which would also help to reduce waiting lists and raise funds for hospital services.

The letter was headed “DNA and Hospital Waiting Lists”

save-our-health-service“Madam, – Sheila Gorman (February 19th) notes that last year St James’ Hospital had almost 25,000 “DNAs”. As she explains, a “DNA” is someone who did not attend the hospital for their appointment. They did not call to cancel or postpone and so the hospital’s time was lost.

In my own area of Pembroke-Rathmines, St Vincent’s Hospital had 26,878 “DNAs” last year.

Assuming similar figures for hospitals across the country, waiting lists could be cut dramatically by appealing to those who have made medical appointments which they no longer require to cancel their appointment. This would also help to ensure that those most in need of medical attention get it sooner.

In the UK, NHS dentists request a £20 deposit from patients booking an appointment. This is later refunded or discounted from the bill. If the patient does not attend,and fails to cancel in time, the dentist keeps the £20. A similar scheme for our hospitals would either reduce waiting lists by hundreds of thousands or raise millions of euro to provide better services.

Could this be a simple way to improve our own health service for medics and patients alike?”

Source: The Irish Times online.

There are probably lots of reasons why so many public patients do not attend for hospital appointments but I would say prime amongst them, is a lack of respect for our inefficient health service. I’m all for making our present health service more efficient but only if it results in improved patient care. The sooner we get a system of universal health insurance in place, the better.

For anyone interested, world-famous cancer specialist, Professor John Crown will address a Public Meeting in Blanchardstown tomorrow evening. The meeting, hosted by Deputy Joan Burton of the Labour Party, will deal with issues relating to the future of Connolly Hospital, Blanchardstown and will facilitate questions by members of the public.

Where? St. Brigid’s Community Centre, Blanchardstown
When? Thursday 5th March 2009 at 8pm

Prof. Crown will address the meeting on the importance of introducing universal health insurance to put an end to our 2-tier health system.