An audit of failure to attend rates
Introduction
Efficient running of a dental practice relies on patients remembering and attending promptly for their appointments.If a patient fails to attend or cancels with short notice then this wasted clinical time leads to increased running costs and reduced morale of the dental team.It is therefore in the interests of the practice to ensure all possible is done to help patients remember their appointments.This audit intends to investigate the number of failed appointments and short notice cancellations over the course of one month with a view to reducing this wasted surgery time.
Method
All 3 dentist in the practice were involved in this audit.Dentists PM and GM are fully private, and dentist AH is fully NHS.Each recorded the number of failed to attend (FTAs) and short notice cancellations (SNCs) over the course of a one month period (see data sheet 1 AH, PM and GM).More information was recorded regarding the appointment e.g. time and day, the reason (if given), the duration of appointment and how much notice was given, if the appointment was offered to another patient, if the patient was a regular attender and what treatment had been planned for that appointment.It was hoped that this would help identify patterns in the FTAs/SNCs to see if particular times, dates or treatment types were particularly poorly attended.It was planned that after all the information was gathered over the month that the 3 dentists would meet to discuss the results.They would also discuss whether any changes could be implemented to improve the statistics and how the practice could go about doing so.
Results
The results showed a total of 16 hours and 45 minutes of wasted clinical time from 39 appointments due to FTAs and SNCs.8 hours of this was from AH’s appointment book alone (GRAPH).GM lost 5 hours and 30mins, PM lost 2 hours 45 mins
Graph showing amount of clinical time wasted due to FTAs (hours):
It was found that the majority of appointments were missed on a Monday:
Of the 39 missed appointments, only 6 were offered to another patient.
The most commonly missed appointments were for restorative treatment, then exam appointments and emergency appointments.
The majority of patients were regular attenders (22/39).
Changes identified and action required/implemented
It is clear from the results that there is a problem to be addressed.The majority of the wasted surgery time was from the NHS appointment book.There are several reasons which may account for this:it is a relatively new list whereas both private lists are long-term established, meaning that new NHS patients may have attended for pain relief only, or with the best of intentions of completing treatment, then have not returned.Financial considerations may also be causative, as patients on the private plan scheme are used to a regular monthly fee and do not regularly have to pay further costs unless more extensive treatment is required.NHS patients who are not exempt would have a financial outlay for all treatment required.
Another clear issue is the evidence that wasted clinical time was not being regularly offered to another patient.This is obviously not always possible in the event of an FTA, but as most patients live within the locality of the practice, it was recognised that some may be able to attend quickly if offered an appointment which had been cancelled short notice.
It was decided that patients should be informed of the extent of the issue.A sign was therefore planned for the waiting room detailing how much clinical time had been wasted in the previous month.It was also decided that the dentists should take ownership of a ‘cancellation book’ in which details of patients requiring treatment who could attend short notice should a suitable cancellation arise.This would mean there was an available list of patients who could be contacted to make use of otherwise wasted clinical time.It was also discussed whether calling patients coming in for longer appointments the night before would be practical, although it was decided that as text messages are routine sent as reminders then this should not be necessary, but could be implemented in the future should the need arise.
Improvements made
Round 2 date collection followed the same methodology as round 1 (see data collection sheet 2 AH, PM and GM).
The total wasted surgery time was significantly less at 8 hours 15 minutes from 23 appointments.
All 3 dentists had an equal amount of time wasted at 2 hours 45 minutes each.
There were more appointments offered to patients who could attend short notice at 5 out of 23 possible appointments.
Again it was mainly appointments for restorative treatment that was wasted.Most of the patients were, again, regular attenders.
Discussion
Overall there has been a reduction in the amount of surgery clinical time wasted.It is, however, obvious that there is scope for further improvement.This is particularly obvious in the number of appointments which could be offered to patients who can attend short notice. It is difficult to improve further and 100% attendance is unrealistic and therefore likely to never be achieved. Although it was welcomed, the cancellation book was difficult to manage due to staffing and time constraints at reception, as although the dentist may be free, the reception area may not be accessible to arrange appointments. Patients found it interesting to see how much clinical time had been wasted, and it was hoped that it made them realise this was causative when they find it difficult to book an appointment time that suited. It is planned that an running total of time wasted can be kept and this poster updated once a month.
Due to the benefits of reducing the number of FTAs it is planned that this audit will be repeated at regular intervals to ensure standards improve, or do not decline.