Non-Attendance at the Colorectal Clinic: A Prospective Audit

Abstract

Ann R Coll Surg Engl 2008; 90: 377-380 377Non-attendance at hospital out-patient clinics has been a cause for concern for many years with no simple and costeffective solution to date. Non-attendance has potentially adverse clinical consequences for the non-attender, other patients who could have benefited from the appointment and financial consequences for the NHS. To overbook each clinic for the estimated number of 'did-not-attends' is not the ideal solution as it fails to solve the first concern and 'did-notattends' are subject to a degree of randomness. It has been calculated that 15% more appointments than necessary would need to be made to allow for this randomness, 1 which is not a good use of resources. Furthermore, on days where the overbooked patients do attend, this will cause an increase in waiting time in the clinic and will likely breach the Patients' Charter.The reported 'did-not-attend' rate for inner city outpatient clinics varies from 5.4% to 33%. 2,3The clinic speciality appears not to be a major factor in non-attendance. 4 Higher 'did-not-attend' rates are found in young males, higher Jarman index (the 'did-not-attend' rate is higher in deprived areas) and with an interval between referral and appointment date of more than 2 or 3 months. 2,5The reasons for not attending given by patients range from appointment notice to personal or family problems. Previous studies have reported that 5-20% did not receive the appointment notification, 1% received the appointment after the appointment date, 25% stated they had cancelled and 2% rang to cancel but could not get through. 6,7 Several authors have tried various methods to reduce the 'did-not-attend' rate. Telephone reminders have significant- Non-attendance in the out-patient department has financial costs for the NHS and clinical implications to the non-attender and those awaiting an appointment. The aim of this audit was to quantify the percentage of non-attenders at colorectal clinics in a UK teaching hospital, assess which factors affected attendance, establish why individuals fail to attend and to implement appropriate change.

Appointment reminder systems are effective but not optimal: Results of a systematic review and evidence synthesis employing realist principles

“…78,79 The likelihood of inaccurate patient records corresponds with populations at greater risk of non-attendance, 80 including less geographically stable communities such as students, young adults or socio-economically deprived groups who may frequently change address or telephone numbers. 81 Reminders may not be received Successful contact rates for telephone reminders are low ranging from 30% to 60% in most health care settings. Reasons for non-receipt of telephone reminders are that landline calls are often made during business hours (9 am-5 pm), during the working week (Monday to Friday), when it is likely that patients will be out.…”

“…86 In two studies, patients who failed to attend stated that they had already phoned or written to cancel their appointment, indicating difficulties with cancellation systems or internal hospital communication prevented cancellations being passed on to the relevant clinic. 81,86 Lack of tailoring to high risk groups…”

Targeting the Use of Reminders and Notifications for Uptake by Populations (TURNUP): a systematic review and evidence synthesis

“…Four studies 18,101,103,104 acknowledge potential system difficulties hampering cancellation by telephone, outside the context of a reminder system. Problems included:…”

“…l difficulties faced by patients accessing the central booking line (long waiting times, call disconnecting with no option to wait or leave a message, phone engaged) 18,101,103,104 l poor reputation regarding access to the central booking number for the reasons outlined above, discouraging patients from making contact 101 l internal hospital communication problems resulting in cancellations and changes of address not being passed on to the clinic.…”

“…104 Similarly, in another study that explored patients reasons for failure, 14 out of 75 participants stated that they had telephoned or written to cancel their appointment already, indicating possible difficulties in the cancellation system. 103 The convenience of e-mail for cancellation, in so far as there is no need to wait to get through to a receptionist, is proposed by Atherton et al…”