Nonattendance at Outpatient Endoscopy

Background and Study Aims: Nonattendance at outpatient endoscopy leads to inefficiency and delay in diagnosis. We aimed to identify factors associated with failure to attend outpatient gastroscopy and colonoscopy.
Patients and Methods: We carried out a retrospective audit of nonattendance at outpatient endoscopy over a 12-month period at our tertiary hospital endoscopy unit. Attending patients on the same endoscopy list were used as controls. Patient charts and referral letters were reviewed. The information collected included referral source, time between referral and procedure, indication and type of procedure, reason for nonattendance and history of previous endoscopy. Following the audit a trial of telephone reminders was implemented over a 3-month period.
Results: From 2157 outpatient procedures that were scheduled, 263 nonattendees (12.2 %) were identified with 261 controls. Of the nonattendees, 109 (41 %) did not attend for colonoscopy, 121 (46 %) did not attend for gastroscopy and 33 (13 %) failed to turn up for combined procedures. Monday was the most common day of the week for nonattendance (40 % of nonattenders). Nonattendees were younger (46 ± 14 vs. 55 ± 16, P < 0.001), less likely to be referred from a gastroenterologist (P < 0.001) or private practice (P = 0.02) and more likely to be referred from the emergency department (P = 0.007). Subsequent to this, a 3-month period of telephone reminder reduced nonattendance rates from 12.2 % to 9 % (P = 0.03).
Conclusions: Younger patients scheduled for outpatient endoscopy on Mondays who are not referred by a gastroenterologist or private physician are more likely not to attend. These patients should be targeted for interventions designed to increase attendance. Telephone reminders have a modest effect on reducing nonattendance rates.

References

• 1 Mahajan R J, Barthel J S, Marshall J B. Appropriateness of referrals for open-access endoscopy. How do physicians in different medical specialties do?.  Arch Intern Med. 1996;  156 2065-2069
• 2 Murdock A, Rodgers C, Lindsay H. et al . Why do patients not keep their appointments? Prospective study in a gastroenterology outpatient clinic.  J R Soc Med. 2002;  95 284-286
• 3 Scott M, Allen S, Bramford A. et al . Influence of a nurse practitioner on non-attendance rate for barium enema.  J R Soc Med. 2002;  95 448-449
• 4 Hamilton W, Round A, Sharp D. Patient, hospital and general practitioner characteristics associated with non-attendance: a cohort study.  Br J Gen Pract. 2002;  52 317-319
• 5 Sanders G, Craddock C, Wagstaff I. Factors influencing default at a hospital colposcopy clinic.  Qual Health Care. 1992;  1 236-240
• 6 Lloyd M, Bradford C, Webb S. Non-attendance at out-patient clinics: is it related to the referral process?.  Fam Pract. 1993;  10 111-117
• 7 Tibble J A, Forgacs I, Bjarnason I, Przemioslo R. The effects of preassessment clinic on nonattendance rates for day-case colonoscopy.  Endoscopy. 2000;  32 963-965
• 8 Hardy K J, O’Brien S V, Furlong N J. Information given to patients before appointments and its effect on non-attendance rate.  BMJ. 2001;  323 1298-1300
• 9 Sawyer S M, Zalan A, Bond L M. Telephone reminders improve adolescent clinic attendance: a randomised controlled trial.  J Paediatr Child Health. 2002;  38 79-83
• 10 Ritchie P CD, Jenkins M, Cameron P A. A telephone call reminder to improve outpatient attendance of patients referred from the emergency department: a randomised controlled trial.  Aust N Z J Med. 2000;  30 585-582