Despite text reminders, 22% don’t turn up for hospital appointments

The introduction of a text messaging reminder system has only reduced the non-attendance rate for outpatient appointments from 30% to 22%, a study published in the Medical Journal shows.

Despite the decrease in no-shows since the introduction of the SMS system in 2017, the non-attendance rate remains “disturbing and continues to negatively influence Mater Dei’s logistical and operational arrangements and increase waiting times”.

The authors of the study have called for improvements to the way patients’ mobile telephone numbers are added to the hospital‘s electronic database, saying that 39% of patients who did not attend appointments insisted they never received the text reminder.

It is estimated that the average cost to provide a consultation visit as an outpatient is around €3.18 per minute, depending on the speciality.
They are also suggesting that when patients call to reschedule their appointments, the cancelled appointment should be re-allocated to improve efficiency of the clinic.

The study was based on attendance rates at four surgical outpatients’ clinics where the total number of appointments were documented over a period of a month. Non-attenders were contacted via a telephone call and asked to explain their non-attendance as well as being asked if they had received a text-message reminding them of their appointment.

Out of a total of 227 appointments (205 females, 22 males), 49 patients did not turn up, representing a 22% non-attendance rate.

Out of these 49 patients, 41 answered their phone and were interviewed for this study. The rest were not reached because a contact number was not in their physical and electronic records (2 patients) or they did not answer their phone at all (6 patients).

Out of the 41 contacted, 16 (39%) claimed they did not receive a text message reminding them about their appointment, whilst acknowledging that they all have a functional mobile phone and they know how to receive and read a text message.

While recognising the possibility that some of these patients may have forgotten or were reluctant to own up, the authors insist that this should “raise an alert” that the hospital needs to keep mobile telephone numbers updated on the electronic records system. “Wards and outpatient clerks should be reminded to update these records after every patient visit. It might also be possible to share a database with telephone service providers if this does not contravene data protection legislation.”

Significantly only 39% of all the non-attendees contacted the surgical outpatients department beforehand and postponed their appointment to another date. 22% (9 patients) did not know at all about the appointment and 12% (5 patients) forgot completely about the appointment.

Seven patients knew about their appointment but they could not make it and did not inform anyone.

The study also shows that follow-up cases had a higher rate of non-attendance compared to new cases. Dylan Attard, Bertha Grech, and Gordon Caruana Dingli from the Surgery Department of Mater Dei hospital authored the study.