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Spelling out the cost of missed appointments cuts DNAs

Research shows explicit text messages cut missed appointments by a quarter

Mark Gould

Tuesday, 05 January 2016

Sending patients text message reminders for hospital appointments which spell out the explicit cost to the NHS of missed appointments reduces missed appointments by 23%, according to a new study.

Last year around 5.6 million (9% of the total) NHS outpatient appointments were missed in England, according to quarterly hospital activity data. The missed appointment rate at some hospitals and for some clinics is much higher. While it is difficult to establish the exact financial impact of missed appointments, an estimate by the National Audit Office claimed that missed first outpatient appointments cost the NHS up to £225 million in 2012 to 2013. Hospitals often put in place coping measures such as overbooking, but these can introduce their own problems.

While hospitals do send out telephone and text reminders of appointment dates there is no evidence about what they should contain in order to minimise missed appointments.

So a team from Imperial College, the Department of Health and the government's Behavioural Insights Team collaborated with Barts NHS Trust and the text message provider, iPlato carried out randomised controlled trials from November 2013 to May 2014 to see how subtle changes to the wording of reminder messages could affect patient behaviour.

Approximately 20,000 patients at 5 clinics at Barts Hospital (who would have received the standard text message reminder) were randomly assigned one of a number of different reminder messages. The reminders were sent 5 days before their appointment.

The first trial compared the existing standard reminder message in use at Barts (Appt at St Barts Hospital on Sep 26 at 2.30. To cancel or rearrange call the number on your appointment letter) with 3 new messages below.

* Appt at St Barts Hospital on Sep 26 at 2.30. To cancel or rearrange call 02077673200.

* We are expecting you at St Barts Hospital on Sep 26 at 2.30. 9 out of 10 people attend. Call 02077673200 if you need to cancel or rearrange.      

* We are expecting you at St Barts Hospital on Sep 26 at 2.30. Not attending costs NHS £160 approx. Call 02077673200 if you need to cancel or rearrange.

The second trial compared the most effective message from Trial 1 which spelled out the £160 cost to the NHS with three new messages the first of which states that "not attending wastes money"; the second "please be fair to others" and the third which states that failure to cancel or re-arrange would be recorded as a missed appointment.

The ‘specific costs’ message was the only message from Trial 1 to have a statistically significant effect. It reduced missed appointments from 11.1% to 8.4% (p<0.01) - a relative reduction of 23% – a substantial improvement for the NHS.

The Department of Health says the results are of use to NHS organisations that want to reduce their missed appointment rates. "This approach is cost-free (where text messages are already being sent), easy to implement, and may highlight opportunities for further research." 

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