Patients failing to attend hospital appointments contribute to inefficient use of resources. We conducted a systematic review of studies providing a reminder to patients by phone, short message service (SMS) or automated phone calls. A PubMed search was conducted to identify articles published after 1999, describing studies of non-attendance at hospital appointments. In addition, we searched the references in the included papers. In total, 29 studies were included in the review. Four had two intervention arms which were treated as independent studies, giving a total of 33 estimates. The papers were analysed by two observers independently. A study quality score was developed and used to weight the data. Weighted means of the absolute and the relative changes in non-attendance were calculated. All studies except one reported a benefit from sending reminders to patients prior to their appointment. The synthesis suggests that the weighted mean relative change in non-attendance was 34% of the baseline non-attendance rate. Automated reminders were less effective than manual phone calls (29% vs 39% of baseline value). There appeared to be no difference in non-attendance rate, whether the reminder was sent the day before the appointment or the week before. Cost and savings were not measured formally in any of the papers, but almost half of them included cost estimates. The average cost of using either SMS, automated phone calls or phone calls was €0.41 per reminder. Although formal evidence of cost-effectiveness is lacking, the implication of the review is that all hospitals should consider using automated reminders to reduce non-attendance at appointments.

Background: Heart murmurs are common in children, and they are often referred to a specialist for examination. A clinically innocent murmur does not need further investigation. The referral area of the University Hospital is large and sparsely populated. A new service for remote auscultation (telemedicine) of heart murmurs in children was established where heart sounds and short texts were sent as an attachment to e-mails. Aim: To assess the clinical quality of this method. Methods: Heart sounds from 47 patients with no murmur (n = 7), with innocent murmurs (n = 20), or with pathological murmurs (n = 20) were recorded using a sensor based stethoscope and e-mailed to a remote computer. The sounds were repeated, giving 100 cases that were randomly distributed on a compact disc. Four cardiologists assessed and categorised the cases as having "no murmur", "innocent murmur", or "pathological murmur", recorded the assessment time per case, their degree of certainty, and whether they recommended referral. Results: On average, 2.1 minutes were spent on each case. The mean sensitivity and specificity were 89.7% and 98.2% respectively, and the inter-observer and intra-observer variabilities were low (kappa 0.81 and 0.87), respectively. A total of 93.4% of cases with a pathological murmur and 12.6% of cases with an innocent murmur were recommended for referral. Conclusion: Telemedical referral of patients with heart murmurs for remote assessment by a cardiologist is safe and saves time. Skilled auscultation is adequate to detect patients with innocent murmurs.

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Abstract. Wireless phones and text messaging are tremendously popular in many areas of society. However, they are still relatively unused in hospitals where pagers are a pervasive communication device that is notoriously difficult to replace. This paper studies pager and wireless phone use at the oncology department at University Hospital of North Norway. Participatory observation and interviews with physicians are used to provide qualitative analysis about the use, drawbacks and benefits of both technologies. A number of important issues are addressed that should aid designers of next generation mobile communication systems for hospitals. In particular, the data points towards specific features that will be crucial for the overall usability and acceptance of an integrated device that supports paging, voice and text services. Of particular importance will be features that allow users to manage their communication availability and avoid interruptions.

The initial hypothesis of the major clinical and education benefits of telestration in telementoring was not supported. A potential 33% decrease in the duration of the mentored episodes is expected due to the ability to annotate live video content. However, the impact of time saving on the outcome of the procedure remains unclear. Regardless of the quantitative measures, most of the participants and the mentor agreed that graphical annotations provide advantages over verbal guidance.