Optimising outpatient efficiency - development of an innovative 'Did Not Attend' management approach

To examine non-attendance [or Did Not Attend (DNA)] rates in a community mental health follow-up outpatient clinic and evaluate a pragmatic initiative to reduce non-attendance.

Clinical audit of attendance across two community psychiatry outpatient clinics was used to establish DNA rates at baseline. Both clinics sought to reduce the DNA rate and were made aware of the outcome of the first cycle of audit. Clinic A (intervention clinic) introduced an innovative new management approach aimed at reducing DNAs, whilst Clinic B (control clinic) introduced no further systematic measures. The clinics were then re-audited to establish the impact of the changes.

We found that the introduction of the new management approach in Clinic A was associated with reduced numbers of service users failing to attend for a clinic appointment (n = 1134, relative risk 0.59, 95% Confidence Interval (C.I.) 0.44-0.77, NNT = 12). No such difference was identified in Clinic B.

Intervention to reduce the DNA rate is realistically achievable with minimal effort and modest additional cost. The actions required of clinicians are practicable, and can have a direct impact without large-scale organisational change.