Did you know that 2014-2015 2015 around 5.6 million (9% of the total) NHS outpatient appointments were missed in England ? Missed appointments can lead to worse care for patients, inefficient use of staff, and increased waiting times. While it is difficult to establish the exact cost of missed appointments, an estimate by the National Audit Office claimed that missed first outpatient appointments cost the NHS up to £225 million in 2012 to 2013. One reason patients may miss their appointment is that they forget. There is evidence that, by tackling this factor, telephone or text message reminders substantially reduce missed appointments1. There is, however, no evidence for what the reminder message should say.
So a team from Imperial College, the Department of Health (DH) and the Behavioural Insights Team collaborated with Barts NHS Trust and the text message provider, iPlato. Two randomised controlled trials were conducted from November 2013 to May 2014. Approximately 20,000 patients at 5 clinics at Barts (who would have received the standard text message reminder) were randomly assigned 1 of a number of different reminder messages. The reminders were sent 5 days before their appointment.
Trial 1 compared the existing standard reminder message in use at Barts with 3 new messages designed by the research team- these messages reminded patients of the time and date and one of the messages told them not attending an appointment costs the NHS £160 approx.
Trial 2 thencompared the most effective message from Trial 1 with additional messages designed by the research team.
Results
In short, the ‘specific costs’ message was the only message from Trial 1 to have a statistically significant effect. It reduced missed appointments from 11.1% to 8.4% (p<0.01). This is a relative reduction of 23% – a substantial improvement for the NHS.
So what? Well obviously the results are of use to NHS organisations that want to reduce their missed appointment rates. This approach is cost-free (where text messages are already being sent), easy to implement, and may highlight opportunities for further research. Why wouldn't you want to do this The Blonde asks?
You can read the full paper here https://www.gov.uk/government/publications/reducing-missed-hospital-appointments-using-text-messages/a-zero-cost-way-to-reduce-missed-hospital-appointments
For more information For more information, contact Jo Chandler [email protected] or Annabelle Bonus a[email protected] from the Department of Health behavioural insights team.