Background: Failure to attend the clinic without prior intimation, known as "Did Not Attend" (DNA) is a significant global issue. There have been no published studies attempting to reduce DNA rates in breast clinics. We aimed to assess the impact of contacting patients prior to clinic attendance and Short Message Service (SMS) reminder on DNA rates in rapid access new patient breast clinics, evaluate 'Could Not Attend' (CNA) rate, and explore any correlation between age, sex, clinic days and sessions. Methods: Initially, DNAs at the rapid access new patient breast clinic between 01/04/2018 and 31/03/2019 at a district general hospital in the NorthWest of England was assessed (Cycle 1). Changes were introduced in terms of contacting patients prior to offering appointments, followed by SMS reminders nearer the clinic dates. Subsequently, DNA was reassessed between 01/10/2019 and 31/03/2020 (Cycle 2). Results: Following implementation of changes, DNA rate reduced from 8.2 to 4.1% (p < 0.00001). CNA rates were 0.9% (Cycle 1) and 1.1% (Cycle 2) [p = 0.36]. Evening clinics had the lowest DNA rates throughout. DNA patients in cycle 2 were significantly older than those in cycle 1 (p = 0.002). Conclusions: Contacting patients prior to clinic appointments and sending SMS reminders helped reduce DNA rates significantly in rapid access new patient breast clinics. Scheduling clinic sessions with least DNA rates, such as evening clinics, should be contemplated. One should be cautious of mobile phone technology that conveys SMS, which can potentially disadvantage the older age group. This model could be considered across the board to improve DNA rates.
AbstractBackground: Failure to attend the clinic without prior intimation, known as “Did Not Attend” (DNA) is a significant global issue. There have been no published studies attempting to reduce DNA rates in breast clinics. We aimedto assess the impact of contacting patients prior to clinic attendance and Short Message Service (SMS) reminder on DNA rates in rapid access new patient breast clinics, evaluate ‘Could Not Attend’ (CNA) rate, and explore any correlation between age, sex, clinic days and sessions.Methods: Initially, DNAs at the rapid access new patient breast clinics between 01/04/2018 and 31/03/2019 at a district general hospital in the North-West of England was assessed (Cycle 1). Changes were introduced in terms of contacting patients prior to offering appointments, followed by SMS reminders nearer the clinic dates. Subsequently, DNA was reassessed between 01/10/2019 and 31/03/2020 (Cycle 2). Results: Following implementation of changes, DNA rate reduced from 8.2% to 4.1% (p<0.00001). CNA rates were 0.9% (Cycle 1) and 1.1% (Cycle 2) [p=0.36]. Evening clinics had the lowest DNA rates throughout. DNA patients in cycle 2 were significantly older than those in cycle 1 (p=0.002). Conclusions: Contacting patients prior to clinic appointments and sending SMS reminders helped reduceDNA rates significantly in rapid access new patient breast clinics. Scheduling clinic sessions with least DNA rates, such as evening clinics, should be contemplated. One should be cautious of mobile phone technology that conveys SMS, which can potentially disadvantage the older age group. This model could be considered across the board to improve DNA rates.
Background: Despite specialisation, a small subset of general surgeons continues to provide breast services in the United Kingdom. We aimed to
assess breast cancer i) local recurrence rate against the national benchmarks of <5% (for invasive cancer) and <10% (for noninvasive cancer) at 5-
year, and ii) net survival rates against national record of 95.8% and 85.3%, at 1-year and 5-year, respectively.
Methods: All breast cancers (between 01/05/2012 and 30/04/2013) at a district general hospital in the north-west of England were audited. Two
general surgeons provided the breast service. One surgeon performed mostly excisional surgery and acted as a 'generalist'. The second surgeon also
performed level 2 oncoplastic procedures and acted as an internal control as a 'specialist'.
Results: Out of 270 cancers diagnosed, 203 patients underwent surgery. Six patients (out of 180 invasive cancers) developed local recurrences
(3.33%). Two patients (out of 23 patients with Ductal Carcinoma-In-Situ) developed local recurrences (8.69%). There was no signicant intersurgeon variation in practice except a difference in the size of the excised lesions. 1-year and 5-year net survival rates amongst all female breast
cancer patients were 97% and 87.3%, respectively. Overall survival at 5-year was 79.1%.
Conclusions: The results demonstrate that in an unselected cohort of breast cancer patients, general surgeons with interest in breast surgery can
achieve acceptable standards in terms of local recurrence at 5-year, and net survivals at 1-year and 5-year. No conceivable difference in practice
between two surgeons with 'generalist' and 'specialist' skill-mix was noted. Low overall survival might reect wider health issues. This has
implications in planning a local breast service and utilising constrained human resources in the era of specialisation.
Background: Failure to attend the clinic without prior intimation, known as “Did Not Attend” (DNA) is a significant global issue. There have been no published studies attempting to reduce DNA rates in breast clinics. We aimed to assess the impact of contacting patients prior to clinic attendance and Short Message Service (SMS) reminder on DNA rates in rapid access new breast clinics, evaluate ‘Could Not Attend’ (CNA) rate, and explore any correlation between age, sex, clinic days and sessions.Methods: Initially, DNAs at the rapid access new breast clinic between 01/04/2018 and 31/03/2019 at a district general hospital in the North-West of England was assessed (Cycle 1). Changes were introduced in terms of contacting patients prior to offering appointments, followed by SMS reminders nearer the clinic dates. Subsequently, DNA was reassessed between 01/10/2019 and 31/03/2020 (Cycle 2). Results: Following implementation of changes, DNA rate reduced from 8.2% to 4.1% (p<0.00001). CNA rates were 0.9% (Cycle 1) and 1.1% (Cycle 2) [p=0.36]. Evening clinics had the lowest DNA rates throughout. DNA patients in cycle 2 were significantly older than those in cycle 1 (p=0.002). Conclusions: Contacting patients prior to clinic appointments and sending SMS reminders helped reduce DNA rates significantly in rapid access new breast clinics. Scheduling clinic sessions with least DNA rates, such as evening clinics, should be contemplated. One should be cautious of Mobile phone technology that conveys SMS, which can potentially disadvantage the older age group. This model could be considered across the board to improve DNA rates.
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