Impact of pre-appointment contact and short message service alerts in reducing ‘Did Not Attend’ (DNA) rate on rapid access new patient breast clinics: a DGH perspective

Abstract

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.

Causes, impacts and possible mitigation of non-attendance of appointments within the National Health Service: a literature review

“…(2015), the importance of the provision of a tailored service becomes evident once more. The results reported by Kiruparan et al. (2020) are similar to those from Anyaegbu (2021), and reasonable conclusions are drawn from both studies that SMS reminders may be beneficial to target specifically younger patients, and alternative methods should be sought for an older patient base.…”

“…, 2020; Anyaegbu, 2021). However, research collected by Kiruparan et al. (2020) in a large retrospective and prospective study, indicates a shortcoming of this intervention, and suggests that older generations can be disadvantaged as a result of this method.…”

Prediction of Hospital Outpatient Attendance in UK Hospitals: A Retrospective Study Applying Machine Learning to Routinely Collected Data for Patients of All Ages

“…Untargeted interventions to prevent DNAs are common [3]; NHS patients routinely receive email and SMS reminders about upcoming appointments. However, given the relatively small proportion of patients who DNA, any intensive but untargeted efforts such as phone call reminders may well have high administrative costs relative to the efficiency savings they produce.…”

“…Untargeted interventions to prevent non-attendance are common [4]; NHS patients routinely receive email and SMS reminders about upcoming appointments. However, given the relatively small proportion of patients who DNA, manual interventions to improve the DNA rate will be wasted on the majority of patients.…”

“…Untargeted interventions to prevent non-attendance are common [4]; NHS patients routinely receive email and SMS reminders about upcoming appointments.…”