Why was this child not brought?

'Getting to clinic study': A mixed methods study of families who fail to attend hospital outpatient clinics

AIM

Non-attendance rates at paediatric hospital outpatient clinics are high; however, parent-reported reasons for non-attendance are poorly understood. We aimed to identify: (i) modifiable system and parent factors that prevent parents from attending paediatric outpatient clinic appointments with their child; and (ii) parent views on changes that could be made to reduce non-attendance.

METHODS

Interviews were conducted with a random sample of parents of children aged 0-18 years who did not attend scheduled new or review outpatient clinic appointments at a metro, tertiary children's hospital in Melbourne, between 1 May and 31 July 2017. Families were excluded if the principal investigator had previously cared for the child in clinic.

RESULTS

A total of 50 parents completed an interview. Common factors related to non-attendance were reported as not receiving an appointment letter (n = 13, 26%) or text reminder (n = 16, 32%); and difficulties making changes to scheduled appointments (n = 11, 22%). Parents suggested a number of ways hospitals could reduce non-attendance, including flexible clinic times, reduced waiting periods, cheaper parking, consistent text reminders of upcoming appointment and, overwhelmingly, the ability to reschedule via text, removing the need to telephone the hospital.

CONCLUSIONS

The principal reasons families struggle to attend appointments is being unaware of appointments, not receiving letters or text reminders. The lack of correct contact details held by the hospital's electronic medical record suggest systems errors in communication are impacting attendance rates of children in the clinics, and that addressing these internal issues may increase clinic attendance rates.

Children's missed healthcare appointments: professional and organisational responses

AIM

This National Society for the Prevention of Cruelty to Children (NSPCC) funded UK study sought to examine organisational and professional responses to children's missed healthcare appointments.

DESIGN/METHODS

The study comprised two parts: phase I was a web-based scoping and systematic analysis of UK National Health Service healthcare organisations' internal policies on missed appointments. Phase II involved a case study of how missed appointments were managed within one hospital trust, including interviews with hospital-based staff, review of organisational data and examination of policies and 'systems' in place.

RESULTS

Policies accessed were of variable quality when benchmarked against a predetermined set of evidence-based standards. Additional material (eg, board minutes) gleaned through the searches found an apparent disconnect between nationally determined safeguarding requirements and strategies to reduce the cost pressures arising from missed appointments. Findings from the case study included the continuing use of the adult-centric term 'did not attend' (DNA), the challenges that may be inherent in attending appointments (with concomitant sympathy for parents) and a need to further explore general practitioner responses to DNA notifications, particularly given the acknowledged association between missed appointments and child maltreatment.

CONCLUSIONS

The web-based scoping exercise yielded a small number of organisational policies. These were of variable quality when rated against predetermined standards. Other material gathered through the search strategy found evidence that 'missed appointment' strategies aimed at reducing costs did not always acknowledge the discrete needs of children. The case study findings contribute to an understanding of the complexities and challenges of responding to a missed appointment and the importance of taking a child-centred approach.