Much concern is expressed over the waste of hospital resources caused by patients who do not attend (DNA) their out patient appointments. Our practice carried out a survey of these incidents between 24th November 2003 and 13th October 2004. We filtered from incoming mail from hospitals those letters that stated that the patient did not attend, and sent a standard form letter (see below) to the patient seeking the reason for non-attendance. Of a total of 115 letters sent out, we received 56 returns - a response rate of almost 50%.

The reasons given for non-attendance :

Letter came after day and time of appt. 2
Knew about appt., cancelled in writing 2
Did not want appt. 2
Did not know appt. was being made 7
Other 8
Knew about appt. but forgot 14
Knew about appt, phoned to cancel 23

The data shows that although a quarter of patient offered outpatient appointments carelessly forgot, 45% of the sample did take the trouble to cancel, and that the resulting waste of hospital resources was due to inadequate communications within the hospital. It should be noted that two patients cancelled in writing.

Reporting bias would be expected to increase the numbers of those who took action to cancel their appointment, since these individuals would have felt righteous indignation with "the system" for being inefficient. Similarly, reporting bias can be expected to reduce the numbers who own up to forgetting, as humans are averse to admitting failure.

Even if all the non-responders to the survey were "forgetters, this would still mean that 25/115 (21.7%) of the DNA's had gone to the trouble of cancelling, which still shows a significant deficit in hospital administration procedures.

An even more gross failure on the part of the hospitals was the 2 cases ( 3.6%) whose appointment arrived after the time of the appointment.

16% of the responders either did not want the appointment or did not know that an appointment was being made - a reflection on poor communications on the part of us, the general practitioners.

Conclusion

Not all DNA episodes are due to the negligence of patients. A significant proportion is due to poor communication between hospital administration departments.

Standard letter

Dear

We have had a letter from hospital to say that you have missed ahospital appointment.
Please tick which of the following statements are true and return
the form to the surgery. We can then apply for another appointment for you.

* I did not know this appointment was being made

* The notice of the appointment was too short

* The appointment letter came after the time of the appointment

* I knew about the appointment but forgot

* I knew about the appointment but cancelled by telephoning the
hospital

* I knew about the appointment but cancelled in writing

* I did not want the appointment

* Other (Please specify on reverse of this form)

* I would like the surgery to make another appointment for me

Thank you for your help with this. The information will help a survey of
hospital failed appointments we are carrying out.

Yours sincerely

(Name of GPs)

Grateful thanks to Jan Newman for collecting the data for this audit.

Dr Richard Lawson MB BS MRCPsych