Abstract
BackgroundFailure 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.MethodsInitially, DNAs at the rapid access new patient breast clinic between 01/04/2018 and 31/03/2019 at a district general hospital in the North-West 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).ResultsFollowing 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).ConclusionsContacting 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.
Highlights
Failure to attend the clinic without prior intimation, known as “Did Not Attend” (DNA) is a significant global issue
A total of 3600 new patients were expected to attend 383 rapid access breast clinics between 01 April 2018 and 31 March 2019 (Cycle 1). During this 12-month period of Phase 1, 33 patients cancelled their appointments in advance and 293 patients did not attend the clinic with a median age of 38 years, (DNA rate = 8.2%)
Twenty-one patients cancelled their appointments in advance in Cycle 2 and 73 patients did not attend clinic appointments with median age of 47 years, (DNA rate = 4.1%)
Summary
Setting A single breast unit at a district general hospital in the North-West of England. Design (Fig. 1) The study was performed in three phases and data were collected in two cycles. I) Phase 1/ Cycle 1- Assessment of DNA and CNA rates over a 12-month period; Retrospective collection of data. Iii) Phase 3/ Cycle 2- Re-assessment of DNA and CNA rates; Prospective collection of data. Data collection included following information i) Number of patients- a) expected to attend; b) cancelled appointments in advance; c) attended the clinic, and d) failed to attend without prior intimation. Time line of the study period was as follows i) Phase 1 and Cycle 1- Between 01 April 2018 and 31 March 2019 ii) Phase 2- Between April 2019 and September 2019 iii) Phase 3 and Cycle 2- Between 01 October 2019 and
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