A simple solution

Sending text reminders to patients about their appointments is popular and cuts waste, says Laura Cameron

Reductions in staff numbers. Increases in referral rates. Does that sound familiar and are you under pressure to make your service more efficient? If so, simple eHealth strategies may hold the answer.

During the past four years, our busy paediatric physiotherapy service has lost whole time equivalent staffing while our referral rate has increased by 20 per cent.

We needed to find ways to improve our efficiency in order to sustain our service provision in the long term.

I have a keen interest in eHealth and looking at our missed appointment rate seemed the obvious place to start. During a seven-month period, more than 300 appointments were lost to DNAs or CNAs (did not attend or cannot attend). This figure represented nearly a quarter of our available appointments, or five weeks' input from a full-time physiotherapist. Clearly, the situation could not continue. Looking outside my immediate specialist area helped me to provide a solution to our problem.

Services are increasingly using short message service (SMS) appointment reminders in an attempt to improve attendance rates. The technology is readily available, and research strongly supports this approach, with reminders being sent within a week of the appointment date.

An SMS appointment reminder system was set up in our musculoskeletal clinics. DNA and CNA rates over a seven month period were compared with those from the previous year. We assessed patient satisfaction levels using questionnaires over a four-week period. The responses were overwhelmingly positive, showing that patients welcomed the reminders and saw them as a valuable addition to our service. Patients were happy with the clear content of the message and said they had received them at a helpful time in the run-up to their appointment.

Results of the DNA and CNA analysis showed statistically significant differences in both DNA and CNA rates for new appointments after the SMS system was introduced. DNAs fell from 10 to four per cent, and CNAs from seven to two per cent. Similar trends emerged in review appointments. Here, DNAs fell from 14 to 10 per cent, and CNAs from 11 to six per cent.

Overall, the rates of missed appointment rates fell from 22 to 13 per cent, and wasted hours were cut by 53 per cent. A staggering amount, considering what a simple step we took. This change demonstrates how easy it can be for clinicians to use technology to improve their services. With increasing pressures across the UK, and management teams looking to be as cost-effective as possible, physiotherapists must look beyond traditional methods, embrace technology, and demonstrate their forward thinking in improving service efficiencies, with no reduction in the quality of care.

Laura Cameron is a specialist paediatric physiotherapist, NHS Fife

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