Abstract
The financial cost of missed appointments is so great that even a small percentage reduction in Did Not Attend (DNA) rate could save significant sums of money. Previous studies have identified many factors that predict DNA rate, including patient age, gender, and transport options. However, it is not obvious how healthcare providers can use this information to improve attendance, as such factors are not under their control. One factor that is under administrative control is appointment scheduling. Here we asked whether DNA rate could be reduced by altering scheduling policy. In Study 1, we examined attendance records for 4,538,294 outpatient hospital appointments across Scotland between January 1st 2008 and December 31st 2010. DNA rate was highest for Mondays (11%), lowest for Fridays (9.7%), and decreased monotonically over the week (Monday-Friday comparison [χ2(1, N = 1,585,545) = 722.33, p<0.0001]; Relative Risk Reduction 11.8%). This weekly decline was present for male and female patient groups of all ages, but was steeper for younger age groups. In Study 2, we examined attendance records for 10,895 appointments at a single GP clinic in Glasgow. Here again, DNA rate was highest for Mondays (6.2%), lowest for Fridays (4.2%), and decreased monotonically over the week (Monday-Friday comparison [χ2(1, N = 4767) = 9.20, p<0.01]; Relative Risk Reduction 32.3%). In two very different settings, appointments at the beginning of the week were more likely to be missed than appointments at the end of the week. We suggest that DNA rate could be significantly reduced by preferentially loading appointments onto high-attendance days.
Highlights
The Did Not Attend (DNA) rate for outpatient appointments at UK hospitals is approximately 12% [1], in line with other nations [2]
As can be seen from the table, DNA rate is highest on Mondays (11%), lowest on Fridays (9.7%), and declines monotonically through the week (Relative Risk Reduction 11.8%)
DNA rates were generally higher for males than for females, and highest overall for young males [14 16 28]
Summary
The Did Not Attend (DNA) rate for outpatient appointments at UK hospitals is approximately 12% [1], in line with other nations [2] These missed appointments cost the UK health system an estimated £600 M per year [3]. We expected DNA rate follow the psychological peaks and troughs of the weekly cycle, with emotionally positive days boosting patient resilience and improving attendance [27]. To test this hypothesis we conducted two independent analyses, the first based on national outpatient data across Scottish hospitals, and the second based on attendance data from a general practitioners’ (GP) clinic in Glasgow, Scotland. To test for a weekly trend in nonattendance, we categorised the remaining 4,463,369 appointments according to weekday, and calculated DNA rates (i.e. the percentage of appointments that were missed) separately for each weekday
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
