BMJ  2003;327:E91 (4 October), doi:10.1136/bmjusa.02020005 (published 28 August 2002)

BMJ USA: Letter

RAPID RESPONSES FROM BMJ.COM

Non-attendance at surgery

This article originally appeared in BMJ USA

Editor—The article by Hardy et al and the recent editorial by Sharp and Hamilton¹ draw attention to the perennial problem of non-attendance at outpatient clinics. However, the impact of non-attendance for surgery, on health services, remains largely uninvestigated, despite the fact that cancellations on the day of surgery are an important parameter in the compilation of hospital league tables. Non-attendance for surgery on a case-by-case estimate is more expensive compared with outpatient non-attendance, at about £100 ($144.62) for minor cases and £800 ($1 156.94) for majors for surgery non-attenders.

We evaluated 100 consecutive women who failed to attend for surgery in our unit, and found that the reasons for non-attendance at surgery were similar to the reasons for failing to attend outpatient appointments—namely, forgetting the appointment, a long interval between attending the preadmission clinic and the proposed operation date, intercurrent illness, and domestic and work commitments. Women also declined to attend for surgery when menstruating, as a result of embarrassment or genuine fear that menstruation will adversly affect the outcome of their operation. Poor communication between the hospital on the one hand and patient/general practitioner on the other was also an important reason for non-attendance.

South Tyneside Healthcare Trust, UK Umo.Esen{at}eem.sthct.northy.nhs.uk

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Was it the information or the reminder?

Editor—How sure can we be that it was the information contained in the pack sent two weeks before the appointment that improved the non-attendance rate? Other studies aimed at providing information have had no effect on the non-attendance rate,¹ so my interpretation is that the study tested the effect of a reminder, albeit an informative one. The rate in those who received a pack but no reminder phone call was 7.3%, compared to the historical rate of 15%. This lower rate is the norm for patients given appointments two weeks after referral.² Halving the rate is very similar to previous reports of using reminders. ^{3 4} The authors quote a poor reduction in non-attendance with reminders, but their reference was to a mammography clinic, which is likely to be unrepresentative of most hospital experience. The reminder phone call could then be regarded as a second reminder, of approximately equal effect.

Whatever the exact mechanism for the reduction, the study was a success. Other clinics for patients with chronic disease should take their finding aboard.

R&D general practice, Exeter EX1 1SR, UK W.t.hamilton{at}btopenworld.com

References

1. Hamilton W, Round A, Sharp D. Effect on hospital attendance rates of giving patients a copy of their referral letter: randomised-controlled trial. BMJ 1999;318:1392-1395 [Abstract/Free Full Text]
2. Beauchant S, Jones R. Socio-economic and demographic factors in patient non-attendance. Br J Healthcare Management 1997;3:523-528
3. Read M, Byrne P, Walsh A. Dial a clinic—a new approach to reducing the number of defaulters. Br J Healthcare Management 1997;3:307-310
4. Sims J. How missing patients can be urged to attend. Healthcare Management 1995;16:17-18

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