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Development and evaluation of a 'was not brought' pathway: a team approach to managing children's missed dental
1Leadership Fellow (Safeguarding Children) and Speciality Registrar in Paediatric Dentistry,Health Education England Yorkshire and the Humber and Charles Clifford Dental Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. jen.kirby@nhs.net.
Insights
A new pathway for children and young people (CYP) with missed healthcare appointments improves safeguarding. This system enhances information sharing among professionals, ensuring child welfare and boosting dental team confidence.
Area of Science:
- Pediatric Healthcare
- Child Safeguarding
- Public Health Policy
Background:
- Missed healthcare appointments for children and young people (CYP) can indicate neglect.
- Healthcare providers should consider 'was not brought' (WNB) status and early information sharing for child welfare.
- Existing protocols may lack standardized approaches for managing missed CYP appointments.
Purpose of the Study:
- To develop and evaluate a new pathway for managing missed community dental service (CDS) appointments for CYP.
- To assess the pathway's effectiveness in facilitating safeguarding information sharing.
- To improve healthcare provider confidence and decision-making in cases of missed appointments.
Main Methods:
- Development of a WNB-CYP pathway including flowchart, patient notes, and letters.
- Piloting the pathway in a CDS clinic over eight months.
- Service evaluation through retrospective record review and staff interviews.
Main Results:
- A WNB rate of 10.8% (134 of 1,238 appointments) was observed.
- The WNB-CYP pathway was consistently followed in 84.3% of cases.
- Three-quarters of missed appointments were rebooked within three weeks; information was shared with other professionals in 25 instances.
- Staff reported high engagement, acceptability, and improved decision-making and communication without increased workload.
Conclusions:
- The WNB-CYP pathway effectively facilitates early and consistent safeguarding information sharing for missed CDS appointments.
- The pathway improved dental team confidence in managing missed appointments and safeguarding concerns.
- The standardized approach supports multidisciplinary collaboration and promotes child welfare.
Abstract:
Introduction Children and young people's (CYP) missed healthcare appointments may be an indicator of neglect. Healthcare providers are encouraged to consider the child as 'was not brought' (WNB) and to assess the need for early multidisciplinary information sharing to safeguard and promote welfare.Method A new WNB-CYP pathway (flowchart, template patient notes, template letters) for missed appointments was developed. After piloting at one community dental service (CDS) clinic for eight months, a service evaluation was conducted via retrospective review of records and semi-structured interviews with staff.Results Of 1,238 appointments for CYP, 134 were missed (WNB rate 10.8%) by 91 children. The WNB-CYP pathway was followed consistently 113 times (84.3%) and, when used, three quarters of WNBs were rebooked after communication with parents within three weeks. Written information was shared in 25 cases with general medical practitioners and other health and social care professionals. Staff reported high levels of engagement and pathway acceptability; it relieved uncertainty and supported decision-making, teamwork and inter-professional communication without increasing daily workload. Following minor amendments, the pathway was rolled out service-wide with similar success.Conclusion A new WNB-CYP pathway facilitated early and consistent sharing of safeguarding information with other professionals about missed CDS dental appointments and improved dental team confidence.