Can outpatient non-attendance be predicted from the referral letter? An audit of default at neurology clinics.

Data obtained from new patient referral letters to regional and peripheral neurology clinics were studied prospectively over a 6-month period in an attempt to determine factors predicting non-attendance. Attendance at peripheral clinics was significantly better, confirming their value. At regional clinics, factors associated with non-attendance were male sex, patient age less than 50 years, urban home address, referral from Accident and Emergency Departments, symptom duration less than 12 months, and wait for appointment more than 2 months. Of these, referral source and waiting time were identified as factors which could be modified, confirming that this analysis of referral letters was a useful exercise.     

Non-attendance at ophthalmology outpatient clinics.

Non-attendance at outpatient clinics is a common problem, resulting in inefficiency and wasted resources. To establish the reasons why patients failed to attend their outpatient clinic appointment and to assess what proportion of these failed attendances were potentially preventable, we conducted a 13-month prospective postal survey of clinic non-attenders to our hospital. Of 5248 appointments made during the study, 521 were not kept (9.9%). Of these, 224 patients replied to the questionnaire, a response rate of 43%, with new patients more likely to not attend than old patients (odds ratio 2.7, P < 0.001). From the replies, 27.3% of non-attendances could be described as 'clerical error' with a further 17.9% due to patients failing to remember their appointment. Based on the replies received, a better organized outpatient booking system and a simple postal reminder could potentially prevent at least 40% of non-attendances.     

Factors affecting non-attendance in an ophthalmic outpatient department.

The object of the study was to establish the non-attendance rates in an ophthalmic outpatient department and any non-attendance patterns that may be useful in managing future outpatient resources. A detailed retrospective survey of monthly non-attendance rates was carried out in the outpatient department of a dedicated eye hospital over a 1 year period looking at differences in non-attendance between morning and afternoon clinics and new and review patients. A total of 43,004 scheduled outpatient appointments predominantly from the suburban population of the Merseyside region were made at St Paul's Eye Hospital from the 1 February 1990 to 31 January 1991. Five thousand four hundred and twenty-four appointments were missed giving an overall non-attendance rate of 12.6%. Non-attendance rates for morning and afternoon appointments were 12.0% and 13.0%, respectively: and for new and review patients, 11.9% and 12.8%, respectively. Logistic regression analysis showed that patients with afternoon appointments were on average 1.10 times more likely to non-attend than morning patients (P = 0.002), and that review patients were 1.09 times more likely to non-attend than new patients (P = 0.04). In order to maximize outpatient department efficiency, a reduction in non-attendance is essential. Establishing patterns for non-attendance provides us with a framework around which we can plan measures to compensate for outpatient non-attendance.     

Non-attendance at outpatient clinics at the Regional Hospital, Galway, Ireland

This paper examines the issue of non-attendance at outpatient clinics at the Regional Hospital, Galway, from the viewpoint of the patients who include both urban and rural residents. The results of a questionnaire survey of outpatients attending general and specialist medical and surgical clinics illustrate that very substantial costs are incurred and long periods of time are spent travelling by many patients. Females, and married females in particular, experience special difficulty in keeping appointments. Non-attendance increases as the cost of transport increases but many patients seriously underestimate the real cost of travel. Patients who have been attending over long periods of time have the worst record of non-attendance. It is recommended that any reorganisation of hospital outpatient systems in rural areas such as Western Ireland should take account of the particular needs of widely dispersed populations.     

Patients'' views on how to run hospital outpatient clinics.

To investigate patients' views and expectations when attending outpatient clinics a questionnaire-based study was performed. The questionnaires asked about appointment systems, continuity of care, staff appearance, chaperons and medical students. Patients wanted fixed appointment times, to see the same doctor on successive visits, for the staff to be formally dressed and to have chaperons during examination. The number of medical students should be restricted especially for women patients. Staff should be sensitive to patients' needs.     

The prevalence of HIV in pregnant women at 3 outpatient clinics in Amsterdam

Pregnant women who were seen in 3 hospitals in Amsterdam were tested for antibodies to HIV, after informed consent. Out of 2,308 eligible pregnant women, 2,094 (90.7%) participated by name and 21 (0.9%) anonymously; 193 (8.4%) refused to participate. Among refusers there were significantly more women with a non-Dutch nationality or born in other countries. Of 2,115 pregnant women, 6 were found to be HIV-infected (0.28%, 95% confidence interval (0.05-0.51). Among women who at their first prenatal visit reported no AIDS-risk factor either for themselves or their partner(s), the HIV prevalence was 1/1,893 (0.05%) and among women with such risk factor the prevalence was 5/180 (2.78%). Three of the seropositive pregnant women knew before they were tested that they were HIV-infected. Of the 6 HIV-infected women one had a spontaneous abortion and the 4 women who were tested within the period when therapeutic abortion was still possible, decided to continue their pregnancy.     

Peripheral outpatient clinics: use, costs, and benefits.

A census was taken of outpatient bookings at all hospitals and health centres in Oxfordshire for the main medical and surgical specialities. Nine per cent of all bookings were to peripheral clinics (that is, those outsie the two main medical centres at Oxford and Banbury). About half of all bookings in the area were made to clinics within three of four miles of the patients' homes. The work load at peripheral clinics was mainly local: 75% of all patients at these clinics lived in the town or parishes adjacent to the town where the clinic was held. Peripheral clinics were associated with a lower work load at central clinics, but a higher overall work load from the town in which they were sited.     

Effectiveness of educational and administrative interventions in medical outpatient clinics.

This study examines the popular belief that increased educational supervision and increased administrative support in university outpatient clinics will improve physician performance, which in turn will improve the process and outcome of patient care. Positive effects on house officers' attitudes and better functioning of clinics with respect to follow-up, information retrieval, and prescribing practices were demonstrated. However, no differences in the process and outcome of care were identified by faculty judges using implicit criteria.