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Policy for the management of patients who DNA

Introduction


The Whittington hospital experiences the third highest DNA rate in the country. One in five patients do not attend their outpatient appointment as planned. Trust clinicians see around 16,000 outpatients each month or 192,000 per year. This DNA rate equates to 38,400 lost appointments per annum, with a value to the NHS of £2.7 million in wasted staff time.

The DNA rate impacts directly on how long patients wait to be seen. If such a high proportion of outpatient slots was not lost on patients who do not attend, sometimes repeatedly, waits for first outpatient appointment would reduce.

Additionally, the rate of DNA is to a particular clinic is unpredictable and this leads to an element of over booking. This in turn means that some clinics run with spare capacity which could have been used for other patients, and some are over full, leading to waits within the clinic and additional pressure on clinical staff to conduct consultations in a difficult environment.

Strategies


Our preferred strategy for dealing with the problem of nonattendance has been extending the successful scheme of partial booking. Unlike the traditional method of allocating appointments, with partial booking patients are written to at the time of referral, informed of the current waiting time, and then written to around 4-6 weeks before consultation and asked to contact the hospital to agree a time and date.

With this system, because patients agree a time that suits them the rate of DNA is far less. We have implemented this system within the specialties with the longest wait first and rates are reducing, it is currently being extended to other specialties.

Consistent Approach


However, it is also critical that the trust maintains a consistent approach in the management of these patients. This policy has been drawn up to ensure that this is the case.

In the event of patients failing to attend their consultation the default position will be for the administration staff not to rebook and to send a standard letter informing the patient and their GP of their non-attendance. The patient will be advised that should they still require an appointment they must contact the hospital within four weeks of receipt of the letter. Where a clinician specifically wishes for the patient to be given a subsequent appointment, due to clinical need, this will be highlighted to the clinic staff on an individual basis.

Primary Care Support


It is important that referring GP colleagues share responsibility in terms of the management of patients who do not attend planned appointment by:

  • letting them know that it is important to keep hospital appointments

  • providing feedback to patients in the event of their DNA that this is unacceptable

  • letting them know that it is important to advise the hospital in advance if they need to change the time of their appointment

Improving Access


In this way, our existing outpatient capacity and clinical staff time can be used to best advantage.

Clinics will run much more efficiently, waiting times will reduce significantly and delays within clinics will reduce, improving the experience for patients at the Whittington.
Last updated17 Mar 2003