Strategies to reduce 'failure to attend' rates in specialist clinics: an implementation framework

High levels of patients failing to attend specialist clinic appointments contribute to extended waiting times and the inherent clinical risk related to deferred care. We undertook three separate sub-studies to better understand failure to attend (FTA) drivers.

An initial quantitative study was performed to identify variables linked to a high FTA rate. A second qualitative study recruited 60 patients to identify barriers and facilitators to clinic attendance. Based on these findings, the following four interventions were evaluated to reduce FTA: (i) increased frequency of SMS messaging, (ii) real-time booking of review appointments, (iii) incorporation of behavioural nudges in SMS messages, and (iv) targeted communications to 'high-risk' FTA patients.

New patients and patients who had previously missed a clinic were at greatest risk of failing to attend. The qualitative analysis identified factors that contributed to high FTA rates. These were incorporated into four FTA interventions that successfully reduced FTA rates, albeit by differing rates (net reduction in FTA ranging from 10.8 to 54.9%).

We described an integrated approach to reduce FTA rates in specialist clinics, thereby improving clinic capacity and reducing the risk of adverse clinical outcomes related to deferred access to care.