While acute hospitals currently have in place a variety of DNA policies, a new policy has been developed as part of the Special Delivery Unit (SDU) Outpatient Performance Improvement Programme. This Programme is being implemented nationally over the period 2012 to 2015 to remodel the provision of Outpatient Services to patients in acute hospitals. The programme will be delivered in a phased manner and a series of Technical Guidance documents will issue to all hospitals covering amongst others (a) Governance and Accountability structures (b) the Management of Referrals (c) the Management of Waiting Lists, Booking and Scheduling (d) the Management and Delivery of Outpatient Clinics (e) the Management of DNAs (f) Clinical Outcome Management and (g) Discharging Patients from Outpatient Services. The first Technical Guidance Document issued on August 20th, 2012, with the key focus of putting governance and accountability structures in place, minimising risk and beginning the process of making robust the manner in which patient referrals are handled and triaged. This document also sets a requirement of a minimum of 6 weeks notification of leave for all outpatient staff.
With regard to the specific question regarding DNA numbers, Table 1 sets out a yearly sum of patients who missed scheduled appointments (did not attend) from 2008 to 2010, along with those who attended and total number of appointments booked (supplied by the HSE Business Intelligence Unit). The DNA rate is calculated by taking the number of missed appointments (DNAs) as a rate of the sum of the total number of attendances and missed appointments. While hospitals returned activity, including DNA data across 2011, this data was not compiled / processed by BIU due to the roll out of the Outpatient Data Quality Programme.
Table 1. Outpatients - Attendances and DNAs 2008, 2009, 2010
|
Year
|
No of New Attendances
|
No of Return Attendances
|
No of Appointments Missed (DNA)
|
No of Return Appointments Missed (DNA)
|
All Appointments Booked
|
DNA as a % of all appointments booked
|
|
2008
|
860,910
|
2,428,007
|
142,404
|
414,295
|
3,845,616
|
14.5
|
|
2009
|
930,014
|
2,489,691
|
161,862
|
428,702
|
4,010,269
|
14.7
|
|
2010
|
999,978
|
2,583,312
|
168,067
|
429,051
|
4,180,408
|
14.3
|
RAW DATA SOURCE: HSE BIU
It is difficult to quantify the financial and administrative cost of DNAs as the costs relate largely to human as opposed to consumable resources. The main area of waste resulting from patients not attending scheduled clinics is the effort invested in the pulling and preparation of health care records (charts) and the smaller, albeit significant cost, of processing appointment letters and associated costs such as postage, text messages, etc.
In situations where patients do not attend, for the most part, staff are occupied attending to other patients in the outpatient area (as many clinics are over-booked) and thereafter, return to their other duties in the general hospital, such as ward work, theatre work and medical administration work such as the typing and processing of medical notes and charts.
Most importantly, however, is the effect of DNAs on outpatient waiting lists and wait times. In 2010, almost 600,000 appointments were missed by patients on hospital waiting lists. Current outpatient waiting lists do not exceed 400,000 patients. It is clear, therefore, that the already limited capacity for the system to attend to all patients on the waiting list in a timely manner is being impacted further by these missed (and therefore wasted) appointment slots which prevents this slot being utilised by another patient still waiting for his/her appointment.
I am determined to do all that is possible to minimise this waste and reduce waiting lists. If a patient finds they cannot attend the appointment they have been given I would appeal to all such patients to inform the clinic concerned as soon as they know they cannot attend.
