Q Exchange
DNAide – Reducing the impact of missed appointments (Did Not Attend’s)
- Proposal
- 2023
What is the challenge your project is going to address and how does it connect to the theme of 'How can improvement be used to reduce delays accessing health and care services'?
The NHS conducts approximately 100m outpatient appointments per year. However, many patients fail to attend. These incidents are classed as DNAs (Did Not Attend).
In 2020-21 there were 5.6m DNAs. Given the average cost of an outpatient appointment is £120, the cost of DNAs to the NHS is £672m per annum.
In addition, DNAs introduce mismatches between demand and capacity, increasing delays and waiting times for those patients who do attend.
A particular issue is repeat non-attendance; one study revealed that 19% of GP patients miss more than two appointments in a three-year period.
Some healthcare providers have implemented measures to reduce local DNA rates (E.g., sending text messages (£1) and letters (£4). These interventions have seen some limited regional success, but the system-wide problem remains.
More needs to be done to prevent DNAs and relieve the associated cost and time burdens for the NHS.
What does your project aim to achieve?
The aim of the project is to mitigate the negative impact that DNAs have on wait times in the NHS.
To consider a different sector, the UK law allows speeding motorists to take a “speed awareness course”. These are designed to change attitudes towards speeding and are effective in reducing re-offending by up to 23%.
There is no similar intervention for DNAs, and we believe that by creating the healthcare equivalent of the speed awareness course, we can:
- Reduce overall DNA rates.
- Reduce the chance of “re-offending”.
- Reduce wait times for all patients.
We wish to build a digital system called DNAide to test this. DNAide will extract missed appointments from an electronic patient record, in addition to patient contact details. We will then share a link with these patients, inviting them to watch a short educational video, and provide optional feedback on why they did not attend.
How will the project be delivered?
The project will be delivered in partnership between Blüm Health Ltd and Somerset NHS Foundation Trust.
Blüm’s clinical and technical expertise is ideally suited to this project, with a track record of delivering seven NHS-ready software solutions in the last two and a half years.
Our approach to delivering the project will be as follows:
- Create an MVP for DNAide which can be used to start gathering data, incorporating patient and public involvement as early as possible.
- Launch DNAide at Somerset NHS Foundation Trust, implementing any required changes once the MVP is in use.
- Observe how many instances of repeated non-attendance are prevented by DNAide, and use this to create an economic evaluation of the solution.
- Establish a commercial strategy to allow for the financial sustainability of the project.
- Ensure that the solution is accessible and usable for patients.
How is your project going to share learning?
Project milestones, successes and learning will be shared throughout the Q Community in the format of blogs, articles and social media posts.
The project and its outcomes would be shared nationally through conferences, improvement events, and through ICS networks to help support others in reducing the financial and efficiency burdens of DNAs.
We expect the project to generate important insights about why patients miss appointments, and we commit to sharing these insights with the digital health community in order to generate further ideas. For example, if the project identifies that some patients miss appointments due to travel/parking costs, what can be done to address that?
How you can contribute
- Do you have any general feedback on our idea and how it could be improved? What assumptions are we making, and are there any blind spots in our thinking?
- Have you ever been involved in efforts to reduce DNAs in your own hospital/Trust? Tell us what you did and what you learned.
- Do you have experience in patient engagement and/or designing educational content for patients? Get in touch to see how you can help.
- Can you help us to understand the psychological drivers behind DNAs, and other relevant behavioural factors we need to take into account? We'd love to hear from you.
- Are you active on social media and more broadly within UK digital health networks? Please share our idea and encourage others to participate.
Plan timeline
| 1 Jul 2023 | Project launch - define system requirements and specifications |
|---|---|
| 30 Sep 2023 | Completion 1st iteration of software development |
| 30 Sep 2023 | Design and test patient educational content with PPI input |
| 30 Nov 2023 | Completion of live pilot of DNAide at Somerset NHSFT |
| 30 Nov 2023 | Continually analyse feedback and usage, make improvements, test and revalidate |
| 22 Dec 2023 | Complete final report of findings and recommendations for dissemination |
| 22 Dec 2023 | Complete strategy for commercialisation |
Comments
Helen Crimlisk 23 Mar 2023
Could we think about why we use the term DNA
I'm not sure about the term re-offending here either?
- it puts blame on patients rather than systems? Many patients who don't attend actually CAN'T attend - didn't get letter in time, couldn't afford bus fare, don't speak English, are immobile, have caring responsibilities etc..
Do you think there is a way of allowing exploration of reasons before providing information which may or may not be relevant?
Michael Watts 27 Mar 2023
Hi Helen, thank you for your comments and you are quite right - "re-offending" is a clumsy term, but one that we simply transferred from a motoring context, where this idea originated.
We certainly need to give some careful thought to how to include the patient's voice in this, and ensure that they are an active participant rather than feeling they are being penalised or "ticked off" in any way.
Paul Sullivan 20 Mar 2023
1) I was involved once in work around DNAs. What we found was that in >90% of cases, either no appointment letter had been sent out, or it had actually been posted AFTER the date on the appointment. I wonder if worth looking at this, before using the phrase "repeat offenders" (which could be construed as not patient-centred in tone).
2) the DNA rate is often relatively constant for a particular clinic. One successful approach often used is to do what airlines do, overbook by the expected number of DNAs. Sometimes everyone turns up and you get a short lunch break. Is that worth a try?
Michael Watts 27 Mar 2023
Thanks for sharing these thoughts Paul, and that's a very interesting statistic. Was this for a single department or across an entire hospital/trust?
We know that deliberate overbooking is being used, and there are some interesting projects around the use of AI and predictive analytics for DNAs. However, the missing piece of the puzzle seems to be engaging with patients themselves following a DNA, discovering the reason for their non-attendance (if they're willing to share), and supporting them accordingly to reduce the risk that they fail to attend again.
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