Outpatient appointment non‐attendance and unplanned health care for children and young people with neurological conditions: a retrospective cohort study

Abstract

ABBREVIATIONS CNA Patient could not attend (patient cancelled appointment) DNA Patient did not attend (patient did not cancel but did not attend) GOR Government Office Region NHS National Health Service PCA Provider cancellation of appointment AIM To test the hypothesis that children and young people with neurological conditions who missed outpatient appointments have more emergency inpatient admissions and Accident and Emergency centre (A&E) visits than those who missed none. METHOD Retrospective cohort of individuals aged up to 19 years with neurological conditions, identified from routine hospital data in England, UK from April 1st, 2003 to March 31st, 2015 using an International Statistical Classification of Diseases and Related Health Problems, coding framework. Counts of emergency inpatient admissions and A&E visits per person per year were modelled (random intercept negative binomial regression) with outpatient attendance the independent variable of interest. RESULTS The cohort numbered 524 613 individuals. Those who missed outpatient appointments had 19 per cent (95% confidence interval [CI] 18-19) more emergency inpatient admissions and 16 per cent (95% CI 15-17) more A&E visits per year than those who missed none. 'Did not attends' had a larger increase in unplanned health care than patient or provider cancellations. If no appointments were missed, the models predict there would have been 107 000 fewer A&E visits from

Effects of a comprehensive reservation service for non-emergency registration on appointment registration rate, patient waiting time, patient satisfaction and outpatient volume in a tertiary hospital in China

“…With the expectation of an increasing global population and an increase in overall life expectancy over the next 30 years, governments all over the world are striving to expand the scope of health services [1, 2]. In addition, waiting time in outpatient clinics are regarded as substantial obstacles and needs to be reduced worldwide [3, 4]. Clinical practice has suggested that the appointment registration process is the responsibility of hospital management.…”

Missed outpatient appointments and unplanned healthcare: the real question is ‘why’?

“…Missed outpatient appointments, whether the patient fails to attend or the appointment is cancelled by the provider, are a huge cost burden to health services and a waste of resources . When children are affected, this should also lead to a consideration of the significance and outcomes for the child of their failure to attend the appointment.…”

“…Children and young people with neurological conditions are often required to attend hospital outpatient appointments to manage the condition and their associated health needs. If such conditions are well managed in outpatient clinics, this should result in less unplanned care and a reduction in Accident and Emergency attendance and emergency admissions to hospital . Yet the literature shows that a range of factors can influence children's attendance at such appointments, including parents experiencing child care difficulties; financial, transport, and parking problems; busy and chaotic lifestyles; complex hospital appointment booking systems; lack of weekend or evening outpatient clinics on offer; and even parents and children not being clear about the purpose and importance of the outpatient appointment …”

“…The paper by Jarvis et al is important as it reports on the analysis of existing UK National Health Service data sets for a large cohort of individuals aged up to 19 years and provides clear evidence of an association between children and young people with neurological conditions who missed outpatient appointments and an increase in unplanned care. This was particularly the case for those children and young people who did not attend, and where there was no prior cancellation of the appointment by either the provider or the patient or patient's family.…”

“…A greater awareness of this message can be raised in clinical practice by signposting staff to Nottingham's useful collaborative video animation (https://www.youtube.com/watch?v=dAdNL6d4lpk). The paper by Jarvis et al provides a valuable quantitative picture of the extent of the problem of non‐attendance at hospital outpatient appointments in a large cohort of young patients diagnosed with neurological conditions, but there remains a gap in knowledge about why this is happening. Rightly, the authors recommend the need for future qualitative research to explore the reasons why a child did not attend – or was not brought – for an outpatient appointment.…”