Endoscopy appointments - what drives non-attendance?

Patients are less likely to attend outpatient endoscopy appointments for a number of reasons, including if they are scheduled to attend on a Monday or Friday, a new study has found.

A team from Connolly Hospital in Blanchardstown set out to assess the factors associated with non-attendance of scheduled outpatient gastrointestinal endoscopy appointments.

Non-attendance or ‘no-shows’ result in “wasted resources, financial loss, longer waiting lists and delayed diagnosis of potentially life-threatening diseases,” the team noted.

Yet, despite non-attendance being well recognised as a big problem in endoscopy units worldwide, few studies have investigated the factors associated with it. The team set out to establish these factors using a retrospective observational cohort study of non-attendances in an endoscopy unit over a three-month period.

During the study period, 1,472 patients were scheduled for an outpatient endoscopy, however 191 (13%) of these did not attend. The average age of those who did not attend was 34 years compared to 67 years for those who did attend.

The non-attendance rate of those under the age of 50 was almost double that of those over the age of 50, however no link was found with the gender of the patient.

Overall, non-attendance was found to be much higher among those scheduled for left-sided procedures (30%), those under the age of 50 (21%) non-urgent bookings (15%), and those without health insurance (15%)

Furthermore, non-attendance rates were observed to be higher on Mondays (17%) and Fridays (18%), compared to other days of the week. Non-attendance rates were lowest on Wednesdays.

The study also looked at the effectiveness of the reminder methods used – a reminder letter, a reminder letter and text, and mandatory confirmation by phone call.

The team found that non-attendance was lowest in the mandatory confirmation group (5%), compared to those who received a letter and text reminder (17%) and those who received a letter only (19%).

The study pointed out that many of those who fail to attend an appointment need a further appointment, which adds to the waiting list even more. Non-attendance is “a significant cause of inefficiency in endoscopy units, leading to underutilisation of very costly equipment, manpower, appointment slots and specialist expertise,” it stated.

The Connolly Hospital team noted that it observed a “significant improvement” in attendance following the introduction of mandatory confirmation. It said that while the impact of a telephone call on appointment attendance has been shown in other studies, this appears to be the first study to specifically demonstrate the impact in the context of endoscopy lists.

It added that there was little difference between those who received a reminder letter and those who received both a letter and a text.

The study concluded that the use of mandatory telephone confirmation “is a particularly effective strategy at reducing non-attendance”.

This findings are published in the Irish Medical Journal.