Reducing non attendance to the Musculoskeletal Physiotherapy Service

Community Health Newham’s Musculoskeletal Physiotherapy Service developed a quality improvement project with the aim to reduce their DNA (Did Not Attend) rates.  The service uses a Patient Booking Service and experiences high levels of referrals. When the project started, DNAs were accounting for 180 hours a month equivalent to 1 whole time equivalent physiotherapist. The team tested a variety of different change ideas which resulted in a reduction in the rates of first appointment non-attendance. These included:

• Testing text message reminders using a web platform
• Making changes to the DNA policy
• Testing automated text message reminders

Testing text message reminders resulted in an initial 47% reduction in non-attendance and making changes to the DNA policy resulted in a fantastic further 20% reduction. Although the team did see a 73% increase in DNAs during the summer months this was reduced again by 24% in September and the new DNA rate of 13% has been sustained.

Following the improvements achieved in first appointments DNAs the team went on to test automated text message reminders for all follow-up appointments. They offer more follow-up appointments each week than first appointments. They therefore focused the change ideas on follow-up appointments and this resulted in a 79% reduction which has also been sustained.

Following the initial testing phase the team developed an implementation plan to ensure that the change ideas that they tested were effectively implemented and became business as usual. This implementation plan included the following stages:

• Standardization – Routinely recording and checking patients’ mobile phone numbers
• Documentation – Process mapping the new procedure
• Measurement – Monthly and quarterly review of KPI reports
• Staff – Training for current staff and at induction
• Resource Implications – Savings from previously missed appointments far outweigh cost of sending text messages
• Change and collective leadership – To present and celebrate this project with the rest of the team

This project has been submitted for publication and is a fantastic example of implementation steps and the processes required to assist new change ideas in becoming part of a system.