New reminder text may save €12m a year reducing hospital appointment no-shows

Personal messages were designed to prompt a response

Patients with an appointment at public hospital outpatient clinics can in future expect a new style of text message in a bid to combat the almost 500,000 yearly “no-shows” who fail to turn up for appointments at a cost of millions to the health service.

More than 568,000 patients are on waiting lists to see a specialist at these clinics and when people do not keep their appointment, they are wasting a slot which could be taken by someone in serious need. It can also have implications for the patients themselves who lose out on care.

Because of the lengthy waiting time to see a consultant – years in some cases – patients can easily forget about the appointment date.

Hospitals have been sending reminder text messages for years with limited success. So health officials looked to behavioural scientists to understand people’s actions and what might influence their decisions.

Several types of text messages designed to prompt people to respond were tested in Naas Hospital based on behavioural science.

The text message style which led to the biggest reduction in patient no-shows read: “We are expecting you at your appointment on Thursday 7, September at 15:00 with Naas hospital Dr Deirdre Robertson Pain Clinic. If you cannot attend or have any Covid 19 symptoms please phone (045)841111.”

It led to one in eight non-attendee patients changing their behaviour.

“We suspect it reduced did-not-attendances as it makes it easier to remember the appointment as it creates a stronger association with the appointment,” according to the Department of Health report.

It added personalisation, reciprocity, day in words, a consultant name and clinic name. Adding additional information beyond that did not reduce no-shows further.

It is estimated to be highly cost effective with a benefit to cost gain of between €300 and €445 per 100 appointments.

It is now hoped that as more hospitals make this their template style of text message, no-shows will be cut by 60,000, which would save hospitals around €12m a year.

The rate of no-shows at outpatient clinics in 2022 was 12.4pc. But it varies across hospitals ranging from 5.7pc to 19.3pc.

Commenting on the findings of the redesigned text message experiment, Health Minister Stephen Donnelly said non-attendances at public hospital clinics can lead to the inefficient use of staff time, worse care for patients and increased waiting times.

“By reducing the rate for outpatient hospital appointments, it is possible to increase the number of appointments delivered within available resources. This not only increases hospital productivity, but it is also better for patients,” said Mr Donnelly.

“The paper identifies the best performing SMS reminder, which makes it easier to remember the appointment by creating a stronger association with the appointment.”