Why aren’t all Healthcare providers using SMS appointment reminders?

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Robert Flynn, Consultant Urologist at the Adelaide Meath Hospital in Tallaght, Dublin has written an excellent letter to the Editor in this months Irish Medical Journal that I think deserves a lot more awareness: “The Use of Text Messaging to Reduce Non-Attendance at Outpatients Clinic – a Departmental Experience” P Ellanti, RP Manecksha, R Flynn


Non-attendance at outpatient clinics is a common occurrence and impacts significantly on the efficiency of clinical departments. High rates of non-attendance result in under utilisation of medical, nursing and administrative resources. It also has a negative impact on already overstretched clinic waiting lists. More than half of patients who miss their appointment cite forgetting their appointment or confusion about dates or times as the reason for non-attendance. Several methods have been reported to reduce non-attendance rates, including reminder letters, personalised or automated phone calls, all with varying degrees of success. In an effort to reduce the outpatient clinics non-attendance rate, the Urology department in conjunction with the Information and Communication Technology department commenced the use of a text message reminder, sent to patients three days prior to each patient’s appointment. We audited non-attendance rates at Urology clinics before and after introduction of this service.

Between 2007-2009 there were 25,820 appointments made and there was a DNA of 17.6%. The Hospital then introduced SMS appointment reminders over the next 2 years at a total cost of €1,807 (for 25,820 SMS). Between 2009-2011 there were 27,604 appointments made and there was a DNA of only 12.4%, an overall reduction of 29.5% in no-shows. Somewhat unsurprisingly the initiative was very positive with patients aged 16-30 years with the reduction in DNA’s by patients from this age group falling by 63%.

In absolute figures a service that cost just €900 per year resulted in 500 patients per year attending appointments that they otherwise would have missed.

20 thoughts on “Why aren’t all Healthcare providers using SMS appointment reminders?

    1. Hi Jared,

      Yes I had seen your case study and it reminds be of how counterintuitive your recent 2011 mHealth report was: http://t.co/Az4j3iC

      While I’d be the last person to dismiss the significant cost savings (and patient/customer/provider benefits) I also think you’re being unrealistic in your calculations of the cost saving for several reasons including:

      > It’s hard to be convinced it’s statistically accurate as you had an opt in process and reported twice as many people “opting out” than you had not showing for appointments. This introduces a multitude of statistical issues for example I wouldn’t be surprised if the “opt out” population included patients who were less engaged with their care provider and hence more likely not to show for an appointment. So in effect you may have profiled the patient population and made your findings unreflective of a representative change in total patient behavior.

      > You’ve calculated cost saving as (cost of an appointment) x (the number of additional appointments saved). I don’t think this is reflective of what I’m seeing in clinical practice where a patient not showing doesn’t necessarily equate to total dead time. In many cases I’ve seen that this time is redeployed by clinicians to better serve other patients who can benefit immensely from it.

  1. I think alot of healthcare providers believe that SMS reminders are too costly, or too difficult to set up and use.

    The fact is there are web based SMS reminder services which are inexpensive, and work entirely through the web browser, making SMS reminder technology accessible to all health care providers large or small.

  2. Not sure if this for medics only. I am a very upset oncology patient who missed an important appt due misunderstanding. Please roll out text reminders in all Irish hospitals. Surely we can avail of modern technology in this 21st century . Mary McGrath

  3. Hi Mary,

    Not sure if this for medics only

    Absolutely not. You’re very welcome. Thank you very much for sharing your experience.

    I am a very upset oncology patient who missed an important appt due misunderstanding

    So sorry to hear that you missed your appointment, I appreciate how easy it is for misunderstandings to be made and I really hope the clinic will be understanding and can reschedule things for you.

    Please roll out text reminders in all Irish hospitals. Surely we can avail of modern technology in this 21st century

    Perhaps you could mention this blog post on your next visit to the Hospital. As you’re aware there are huge opportunities for healthcare service providers to use mobile tech to make things easier for Patients and help make their services more modern and efficient.

    To learn more they could reach out to us or the Irish Healthcare Informatics Society with whom we’ve collaborated to produce a mHealth training course that will share with them best practice in the use of SMS appointment reminders as well as other key opportunities to use mobile tech.

    1. Thank you for your reply to my comment David .i did get my appt rescheduled two weeks later. I had in fact read an article in the Irish Independent 14jul with shocking figures of 1300 patients a day missing appointments. In fact 14Jul was the very day I was missing my appointment. I was waiting for a letter from the hospital.When I thought about the fact that my dentist , hairdresser ,TV Co , etc all send text reminders I rang the HSE customer service asking why hospitals did not do the same and I was told that some hospitals were in the process of planning a roll out of the service. I came across your website when I was looking for more information. I certainly will mention it on my appointment on 31 Jul . I am sure that the majority of those patients who missed appointments did not deliberately do so. St Vincents hospital say they reduced their non-attendance by 50per cent by introducing text reminders.Thank you so much for reading this

      Mary McGrath

      1. Hi Mary,

        It’s great to hear that they’ve been able to reschedule your appointment.

        Thank you for pointing to that Irish Independent article. Very interesting, here’s the link for readers who are interested in full details;

        Over 1,300 patients a day are no-shows for their hospital appointments.

        I’m familiar with St Vincent’s system as a connection of mine (Neal Mullen) was the Director of ICT when they set the SMS service up with Grapevine.ie – they’ve published an useful case study:


        Perhaps it’s just my personal experience with snail mail (I get tonnes of ‘junk’ mail and am away travelling a lot) but I find it very disturbing to read in the Irish Independent that a child might be removed from a waiting list because of a simple mix up with snail mail. With waiting lists what they are today in Ireland it’s all too easy to see how snail mail could fail eg. many young families move home.

        A little tip you could try until the Hospitals get their act together might be to try and set the calendar reminder on your mobile. All the smartphones have these and quite a lot of even the more basic Nokia’s etc do also. Walk into any high street mobile store and I’m sure the sales staff will be keen to help you out.

        Best wishes,


  4. HI David

    Just to let you know that during my recent appointment on 31Jul I asked when a text reminder service would be introduced and I was told it was already in operation. I was surprised as I have been attending this particular hospital since my diagnosis in May 2011 followed by treatment and check ups every 3 months . I asked why I was not included and I was told that the box that would indicate I had agreed to text reminders was not ticked. My guess is that my admission was pre the text reminder service being introduced so maybe that applies to all patients in my situation. Maybe hospitals just need to be reminded that their long term patients might like to avail of this service. I am glad to say that I am now included in this service and wont have to worry about missing future appointments.

    Thank you for your advice and help on this and for taking the time to reply to a patient who needs one less worry in her life .



    1. Hi Mary,

      Very interesting finding and thank you for sharing it. I’ve emailed a link to your comment to the MD of a company I know that’s involved in SMS services for Clinics/Hospitals and I’m sure it will get the attention of others who are in control of or in the process of implementing SMS appointment reminder systems.

      Ironically it seems like just the type of small but very important oversight a Hospital can easily pick up on once they move on from basic SMS appointment reminder services and enable Patients to provide direct SMS feedback on their experiences.

      Best wishes,


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