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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.


Reaching out

A study in the USA has revealed the benefits of automated telephone calls for patients with hypertension.  Taking a sample of 64,773 hypertension patients, half were sent a recorded phone message inviting them to have their blood pressure monitored at a clinic whilst the rest received no such invitation.

After four weeks it was found that 32.5% of those who had received a call had controlled their blood pressure against a base of 23.7% for those who had not received a call.  Although researchers did not collect data on measures taken by patients to control blood pressure it is believed the calls played an important part in raising patient awareness.

Certainly this study mirrors the findings of other surveys in the way in which patient care can be improved by a simple call.  Whether by encouraging patients to have a check up or replacing costly health visits with a simple call, the telephone is increasingly playing its part in enhancing health care.

One particularly successful way in which phone calls are being brought into the front line is in reminding patients about their appointments.  Whether issued via automated phone message or by text, a simple reminder can make a substantial contribution towards reducing the number of “no shows.”

This has two benefits.  Firstly it encourages patients to attend booked appointments and secondly it encourages them to notify the health practice should they be unable to attend for any reason.  With an early warning of a cancelled appointment the practice has the chance to book in another patient; thus benefitting the practice, the patient and boosting the overall level of patient care.

In our ever busier lives, it is inevitable that we will forget appointments from time to time and an automated phone or text message can be that vital memory jogger which we all need.  Health care practitioners from opticians to physiotherapists and even vets are using messaging for everything from a reminder to pick up some new medication or book a check up to reminders about appointments which have been made.  For example this writer received a text from their vet recently reminding them to pick up a fresh batch of worming medicine for a pet.

In summary, phone reminders can save “no shows, they can ensure patients receive the treatment which they need and they can help to keep health practitioners busy at all times.

Time to stop sitting around

A study from Leicester and Loughborough Universities has shown that sitting still for long periods of time can increase the risk of diabetes, heart disease and death.  Whilst the trigger limit varies from person to person, those who sit for the longest are at greatest risk, with the strongest association being between sitting still and diabetes.

Dr Emma Wilmot who led the study said that “people convince themselves they are living a healthy lifestyle, doing their 30 minutes of exercise a day. But they need to think about the other 23.5 hours.”  Suggestions to redress the balance include conducting standing meetings, walking at lunch time and typing whilst standing up.

There will be those working in some health fields who will greet the study with a wry smile.  Health practitioners working in occupations such as physiotherapy or who offer beauty treatments can find themselves standing for long periods and so would welcome the chance to sit down at the end of a busy day.  However, for them, the benefits of moving around during the day can be outweighed by the stress of having to catch up at the end of a day; with paperwork and telephone calls taking up time which would be better spent on leisure.

Those who are caught in this trap may well find that using the services of a virtual assistant can enable them to relax at the end of the day, rather than spend several hours on paperwork.  Sometimes thought of as simply providing a telephone answering service, virtual assistants in fact do so much more.  For example, taking advantage of diary management and patient records services means that patient notes will be organised and available at the touch of a button, appointment reminders and invoices sent out and the diary kept up to date.

This means that rather than turning round at the end of a day to remind clients of upcoming appointments , search out patient records for the next day and send out invoices, all the health practitioner needs to do is glance at their diary and then go home to a well earned rest.  Add in the fact that whilst the health practitioner is working the virtual assistant is answering calls and filling up their diary and the overall effect is to reduce no shows and banish non-earning blank times during the day.

So whether the health practitioner is on their feet all day or not, using a virtual assistant service at least means the end of sitting around waiting for patients to show, and paperwork free evenings.

Reducing “no shows”

A recent NHS report revealed that 1 in 10 hospital appointments in 2011 resulted in “no shows”.    This adds up to a staggering 5.5 million missed appointments and costs the NHS £millions each year.  Even if each patient has a genuine reason for missing the appointment, missed appointments have a knock on effect across the NHS.

In announcing the “no show” figures, the then health minister, Simon Burns, said “It is important that people realise that not turning up for their agreed appointments means other patients’ care might be delayed.”  Although the figures were down by 250,000 on the previous year they still have a significant impact on NHS services.

Hospitals are starting to employ a variety of methods in a bid to reduce the number of those who fail to turn up for appointments.   One project in Bedfordshire cut missed appointments by 30% simply by asking patients themselves to write down the appointment time and repeat it back to the receptionist.  Other health providers have started sending reminders to patients by text or e-mail whilst Newham University Hospital doctors now check up on their diabetes patients via Skype.

The problem of missed appointments also affects those in the private healthcare sector.  However with many services such as osteopathy and physiotherapy operating as via comparatively small practices, health practitioners can be torn between the options of treating patients or spending time in administration.  This means that inevitably patient appointment reminders are not sent, raising the chance of missed appointments.

Whilst some private health practices have a policy of charging patients for missed appointments these fees can prove hard to collect and may endanger the patient/practitioner relationship.   There is no point in trying to collect a missed appointment fee if that means missing several other fees in the future.

This is where a virtual receptionist service comes into its own.  Answering the phone, making appointments and sending reminders via text or email, the virtual receptionist service takes the appointment strain, leaving the clinician free to maximise patient time.  Interestingly a study in 2008 showed that those in the 20-24 age group are the most likely to miss appointments followed by the 25-29 and 15-19 age groups. The most tech savvy groups are therefore the worst offenders and a reminder system which takes advantage of text or e-mail could therefore have a significant effect.

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