The problem of “Did Not Attend”s
Why do people miss their Health care appointments? As an NHS
staff member I know that there is a large problem with patients who “Did not
Attend” their appointment (DNA) as it can mean that patients are waiting longer
than they need to for appointments. There are often notices on view at
reception desks about the need to cancel appointments and the cost to the NHS
of missed appointments. There has also been talk of charging people for missed
appointments.
This is an area where there is a real opportunity for the
NHS to save money, and also to help patients receive better care but having
done a very quick search to look at NHS DNA improvement efforts, there was no
obvious evidence base being drawn on as to why patients miss appointments in
the examples I came across. The main assumptions seemed to be patients
forgetting or not caring. There was some work testing interventions to help
patients remember their appointment which showed good results, and behavioural
change interventions which showed having the cost of a missed appointment in a
text reminder helped a little, however I can’t help but wonder if these are
totally irrelevant for many people.
Some research I found into why NHS appointments were
missed in mental health service users in Surrey showed that reminders and then
choice and ease of access were the preferred improvement options in this group
of patients, but I expect that the reasons will vary between different patient
groups and different locations. Surely more effort should be made to understand
why people miss appointments before making wholesale changes?
There has recently been a move to acknowledge the issue of
those who need to be brought to appointments such as children or vulnerable
adults, and to change from DNA to “Was Not Brought” (WNB), as there may be
safeguarding issues. In an abstract I came across looking at reasons for US family’s
not attending appointments, the main reasons cited were transportation problems, wait times, and not knowing the
reason for the appointment.
Personally I hate the “ x Missed appointments at this
surgery has cost the NHS £xxx” message which seems to be up at every reception
area. The people reading these ARE attending (or trying to), and it makes me
feel like I should not be taking up valuable time going at all. Is that really
the message the NHS should be sending out? In fact one of the improvement
projects I came across tested changing these signs to instead show the high
number of appointments used instead, and recommended this approach as more
effective.
In the past I have been so late that I have missed
appointments due to being stuck in traffic and not being able to park anywhere
near (and when phoned to let them know this, being told it will be the end of the clinic by the time
I get there so won’t be able to be seen). My initial thoughts on how to
help reduce missed appointments would be to improve parking and transport, but
this doesn’t seem to be considered an issue by the NHS.
Do people understand enough of the information about when
and where the appointment is, and why they need to attend? Could they be
getting lost or have the wrong time? Is
it true everyone can or will use the telephone to re-arrange an appointment?
What if that person does not have the opportunity to make a private telephone
call during working hours? What if they have no credit on their phone? What if
they are too ill to phone? What if they are being prevented from attending? Surely we should not be quick to judge, but instead try to understand what is
going on.
