Enhancing resource utilisation in outpatient clinics: impact of telephone and text reminders on did not attend and short notice cancellation .

Abstract

Did not attend (DNA) and short notice cancellation (SNC) in outpatient (OP) clinics waste scarce capacity and delay care. We undertook a quality improvement project in general surgery OP clinics with the aim to reduce DNA below the baseline 12.2% and SNC below the baseline 5% using telephone and text reminders to increase OP appointment (OPA) slot utilisation from around 83% towards 85%-90%.We studied DNA and SNC in four consecutive phases in a general surgery clinic. Phase 1: a retrospective baseline OPA attendance; Phase 2: a prospective diagnostic where non-attenders were telephoned within 3 days to complete a questionnaire on reasons for DNA/SNC; Phase 3: Preappointment telephone reminders 72 hours before OPAs; Phase 4: one-way text reminder.Across four phases, 1500 OPA slots were analysed. Baseline utilisation was 82.8% in phase 1 (360 slots; DNA 12.2%, SNC 5.0%) and 83.3% in phase 2 (420 slots; DNA 11.7%, SNC 5.0%). Questionnaire responses: most non-attendees were forgetting their appointment or unable to get through to the hospital to cancel. Phase 3 (360 slots): 286 patients (79.4%) were successfully contacted, 251 confirmed attendance and 35 wanted to cancel, creating potentially reusable slots; DNA fell to 9.4% and SNC to 0.6%, but only 20 of the 35 freed slots were re-booked due to limited booking staff (utilisation; 85.8%). Phase 4: 360 slots, utilisation was 84.7% (DNA 8.1%, SNC 7.2%). Statistical process control charts suggested a favourable trend in DNA and SNC over time but did not demonstrate consistent special cause variation.Telephone reminders led to fewer SNCs and created opportunities to reallocate appointments, but impact was constrained by limited staff. One-way text reminders appeared to reduce DNA but higher SNC, suggesting that reminder systems alone are insufficient. Sustainable improvement in OPA utilisation requires reliable contact information, simple two-way routes for patients to cancel or rearrange, and adequate administrative capacity.