Internal audit of attendances at a psychiatry outpatient clinic

This audit aimed to (a) systematically identify problems related to rates of attendance and non-attendance at one psychiatry outpatient clinic; (b) quantify these problems; (c) implement strategies to improve service delivery; and (d) re-audit after three months.

Specific standards were set in relation to patterns of attendance at the outpatient clinic. Audit was performed over two weeks; changes to practice were agreed and implemented for three months; re-audit was performed.

The initial audit showed that (a) 93 people attended the clinic over two mornings with a non-attendance rate of 13.9%; (b) 30.1% of individuals who attended did not have an appointment; (c) 20.4% of attendances were 'inappropriate'; (d) 2.2% did not live in the clinic's catchment area. Based on these results, the clinic introduced a protocol for individuals who attended without appointment; a protocol for streamlining the provision of prescriptions; and a renewed emphasis on transferring the care of individuals not residing in the catchment area. Three months later, re-audit showed that (a) the number attending over two mornings decreased from 93 to 43, but the non-attendance rate had not changed; (b) the proportion of individuals presenting without an appointment (9.3%) decreased significantly compared to the initial audit (30.1 %); (c) the proportion of 'inappropriate' attendances (9.3%) tended to decrease compared to the initial audit (20.4%) but this was not statistically significant; (d) there was no difference in the proportion of patients who did not live in the catchment area; these proportions were low in both the initial audit (2.2%) and re-audit (2.3%).

A relatively simple audit such as this can result in a more efficient and appropriate delivery of outpatient mental health services. On this basis, there is a need to provide ongoing resources for further cycles of clinical audit in mental health services.