Reducing Missed Appointments

The recent junior doctors’ strike has highlighted the cost of cancelling or delaying treatment both to the NHS and to patients. Whilst emergency cover continued to be provided, the inevitable cancellation of some operations has added to waiting lists and left patients having to manage their conditions for an extended period of time.

Whilst these delays have been occasioned by strike action, on a day-to-day basis the NHS and other health providers are forced to delay or reschedule treatments simply because patients fail to turn up for booked appointments. These ‘space blockers’ not only cost health services in terms of wasted appointment times, they also prevent other patients being treated in their place.

The problem is so acute that many health providers have resorted to adopting systems such as SMS text reminders or telephone reminders in a bid to cut down on missed appointments. Even with these measures in place a department of health report published at the beginning of this year estimates that one in 10 hospital appointments (5.6million) are missed. At an average cost of £160 per missed appointment this equates to a significant amount of wastage, something the NHS can little afford.

In an effort to reduce missed appointments still further, the Department of Health has carried out a research trial looking at the wording used when reminders are sent out. The trial, which was conducted in conjunction with Barts NHS Trust, compared various forms of text message. All started with a reminder of the appointment time and date with subsequent variations including:

  • To cancel or rearrange call xxx.
  • 9 out of 10 people attend. Call xxx if you need to cancel or rearrange.
  • Not attending costs NHS £160 approx. Call xxx if you need to cancel or rearrange.
  • Not attending wastes money. Call xxx if you need to cancel or rearrange.
  • Please be fair to others and call xxx if you need to cancel or rearrange.
  • Please attend or call xxx cancel/rearrange or we will record as a missed apt.

Whilst all of the variations produced a slight reduction on the original SMS which merely asked people to call the number on their appointment letter to cancel or rearrange; the message which specified the cost of not attending was shown to reduce missed appointments to 8.2%, equivalent to a 23% reduction in no-shows. Whilst an 8.2% no-show rate is still not ideal, the reduction in missed appointments still represents a considerable saving to the NHS.

Although this experiment purely related to hospital appointments, it does demonstrate the way in which a careful choice of words can make a difference to the way in which SMS text messages are perceived and actioned. Health professionals may therefore wish to choose a form of wording which best suits their client base, perhaps by undertaking their own trial with a variety of phrases which they feel may resonate with their clients.

Of course, those health professionals who charge for appointments have another option which they can use to encourage clients to attend. Taking credit card details at the point of booking enables health professionals to charge a no-show fee in the event that the appointment is missed. Adding a comment about this no-show fee to an SMS appointment reminder may well encourage patients to either attend the appointment or telephone to rebook.

At the end of the day reducing missed appointments benefits everyone from patients to health professionals as well as the country as a whole. The more timely the treatment, the better the outcome; so it therefore pays for patients to be treated at the earliest opportunity to reduce the chance of the condition escalating thereby requiring additional treatments. If a simple change of words on the SMS text reminder can reduce no-shows by 23% then it is something which all health professionals would do well to consider.