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.

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

  1. [...] This post was mentioned on Twitter by zorgbeheer and TASK Community Care, David Doherty. David Doherty said: Why aren't all Healthcare providers using SMS appointment reminders? http://t.co/Es0OZqB [...]

  2. [...] of how mHealth is improving the efficiency of these expensive pieces of diagnostic equipment? SMS appointment reminders can not only help ensure patients turn up but they can be used to provide patients with notification of appointments that may become [...]

  3. Have you seen how we saved a provider almost 300k in 30 days with SMS appt reminders? http://www.mobilestorm.com/wordpress/wp-content/uploads/CASE_STUDY_Kaiser_Permanente_v1-1.pdf

    • 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.

  4. [...] (who have electoral voting) but we shouldn’t wait on bureaucrats to get their act together. Clinics should be registering their patients mobile numbers anyway and this would be an additional way this database could help [...]

  5. 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.

  6. Anupam says:

    We have integrated SMS reminders for appointments with our online clinic management solution (http://meraClinic.meraMD.com). Lot of doctors/clinics using our solution have reported similar decrease in their no show/late arrival rates.

  7. [...] > Promote opportunities that mHealth enables care providers to save resources so they can better apply their limited funds and free up time so that they can then use it to improve the patient experience. SMS appointment reminders are a good example as they are a key innovation that all care providers should be introducing as there is plenty of evidence of the multitude of benefits for both provider and patients. [...]

  8. [...] Learn about the benefits of SMS patient appointment reminders for improving the efficiency of Hospital services or how small SMS companies like iPlato are working with NHS GP clinics to improve patient response [...]

  9. [...] alternatives eg. the mobile first strategy that’s paying dividends at Kaiser Permanente, replacing appointment letters with SMS reminders, [...]

  10. [...] will love it > Fewer cancelled appointments will ensure your time is used more effectively > There is plenty of evidence of the benefits and cost effectiveness > There are companies that are specialised at providing SMS services to GPs eg. iPlato serve 5 [...]

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