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
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
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
Not all DNA episodes are due to the negligence
of patients. A significant proportion is due to poor communication
between hospital administration departments.
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
* 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
* I knew about the appointment but cancelled in
* 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
hospital failed appointments we are carrying out.
(Name of GPs)
Grateful thanks to Jan Newman for collecting the data for this
Dr Richard Lawson MB BS MRCPsych