Improving medical outpatient clinic attendance


Improving medical outpatient clinic attendanceWhat are outpatient clinics?

To help assess and manage certain medical conditions, patients are sometimes referred by their family doctor to see a specialist at a clinic setting without having to be admitted into hospital; and these are known as outpatient clinics. The first specialist appointment (FSA) is especially important because it allows the specialist to assess the patient’s condition, develop in conjunction with them an appropriate treatment plan and arrange subsequent follow-up at the outpatient clinic.


What are we trying to achieve?

Sometimes, patients do not attend (DNA) their outpatient appointment. Non-attendance can cause negative downstream effects as patients have to be rescheduled and result in other patients encountering delays. In an effort to improve attendance, we initiated the Patient Focused Booking project which aims to:

  • increase patient satisfaction and give patients the convenience to choose a date and time which is suitable for them
  • reduce the need to reschedule appointments for FSAs from 29% to 20% or less for our in-scope medical specialities by February 2016

What did we find?

To better understand why patients did not always attend outpatient clinics, we conducted over 500 patient experience surveys in our medical outpatient clinics at North Shore and Waitakere hospitals.

Our patients told us:

  • "It would be so much better if we had the option to pick a date and time by ourselves"
  • "Being able to select time of appointment as I am dependent on bus"
  • "Would like to do myself rather than have the date and time picked already"
  • "Afternoon appointments are hard for me. I'm self-employed so I lose half a day’s work"

Even though patients DNA for a variety of reasons, a common theme expressed by our patients was that the predetermined time and date provided to them for their outpatient appointment was inconvenient.

We found that 29% of new appointments (FSA) needed to be reworked because:

  • 41% of patients did not attend
  • 59% were rescheduled due to a request by the patient or initiated by the hospital

Breakdown of reworked new outpatient appointments


To further understand our appointment rework rates, we analysed the data by specialty for our in-scope medical specialties and found that:

  • there is a wide variation in terms of rework across the different specialties
  • dermatology’s rework rate at 54% is the highest followed by diabetes at 50%
  • diabetes’ FSA DNA rate at 24% is also the highest amongst the specialties while dermatology’s rework comes mainly from rescheduled appointments at 40%
  • renal has the lowest rework rate at 8% (5% rescheduled and 3% DNA)

Breakdown of reworked new outpatient appointments by specialty


Where to from here?

We are proposing to change our current processes to allow sufficient time and flexibility to enable us to give patients the convenience to choose a date and time which is suitable for them and reduce the need to reschedule appointments.

In the planned Waitemata DHB Patient Focused Booking rollout these are our new process timelines:

  1. Urgent Priority [appointment required within 42 days of date referral is received]
    Patients are contacted by phone to negotiate a date and time by our booking clerks
  2. Semi-Urgent [appointment required between 43 and 56 days of date referral is received]
    Patients will be sent a ‘patient to call’ (PTC) letter asking them to call and choose a date and time that best suits them within the following timelines:
    Timeline for Semi-Urgent (P2) FSA
  3. Routine [appointment required between 57 and 120 days of date referral is received]
    Patients will be sent a PTC letter asking them to call and choose a time and date that best suits them within the following timelines:
    Timeline for Routine FSA

The project will be implemented in a phased approach:

  • Phase 1: Patient focused booking for all FSAs from 28th November 2016
  • Phase 2: Decision to implement Patient focused booking for all follow up appointments