Missed appointments cost the NHS millions of pounds every year

Text message tweak to appointment alerts could save NHS millions

A new study based on one NHS Trust practice has found ‘Did Not Attend’ (DNA) rates can be significantly reduced simply by making reference to the £160 cost the NHS incurs from each missed appointment in the SMS text message sent to patients.

The research study found that when using the new message text, DNA incidents were reduced by 5,800. This figure could have risen as high as 28,900 if the Trust had a record of every patient’s mobile number.

Healthcare providers are increasingly using SMS reminders to reduce DNA rates, with statistics showing in 2012–13 around 5.5 million NHS outpatient appointments were missed in England (9.3 per cent of the total). A recent estimate claims missed first outpatient appointments cost the NHS up to £225 million in 2012–13. If the NHS only had mobile numbers for 20 per cent of patients, this could still potentially avoid as many as 400,000 missed hospital appointments per year, saving the NHS and the taxpayer in excess of £64 million.

The research Stating Appointment Costs in SMS Reminders Reduces Missed Hospital Appointments: Findings from Two Randomised Controlled Trials by Ivo Vlaev, Professor of Behavioural Science at Warwick Business School, Michael Hallsworth, Michael Sanders and Anna Sallis, of the Behavioural Insights Team, Dominic King and Ara Darzi, of Imperial College London, and Dan Berry, of the UK’s Department of Health, is the first to show evidence of the impact of the content in texts sent to patients.

Professor Vlaev said: “Moving from the existing text reminder to the more effective message emphasising the cost of missing an appointment would result in 5,800 fewer missed appointments per year at the NHS Trust in question, at no additional cost. On the same basis, full phone record coverage could result in 28,900 fewer missed appointments for the Trust annually.

“These results show that the wording of SMS reminders significantly affects the extent to which patients miss, attend or cancel outpatient appointments. Moreover, the results show that presenting the specific tariff cost of the appointment produces a DNA rate that is approximately three percent lower than for other messages, a result that we replicated across two trials.

"Telling a patient the cost their missed appointment has on the NHS therefore genuinely persuades some to reconsider.”

The research involved two trials analysing outpatients with a valid mobile telephone number and an appointment. In the first trial, a message including the cost of a missed appointment to the health system produced a DNA rate of 8.4 per cent, compared to 11.1 per cent for the existing message.

The second trial replicated this effect with a DNA rate 8.2 per cent, but also found that expressing the cost implications in general terms without mentioning the exact amount was significantly less effective with a DNA rate of 9.9 per cent.

“The fact that there were no significant differences between the ‘control’ and ‘social norms’ messages means we can be confident that the effect of the ‘specific costs’ message is not being driven by the ‘we are expecting you’ message framing, or the presence of the telephone number,” added Professor Vlaev.

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