Aims Non-attendance at clinic appointments puts children at risk of avoidable ill health. Wasted clinic appointments cost the NHS £700m/year with up to 6 million appointments wasted.
The aim of this study was to assess outcomes for children who DNA, following introduction of a red (urgent appointment sent), amber (further routine appointment offered), green (appointment offered only if requested by family) coding system.
Method Records of 100 children who DNA over a 3 month period were reviewed. Information on age, diagnosis, outcome, was recorded and analysed using Microsoft Excel (figure 1).
Results 55 DNA’s were classified green, 43 amber and 2 red (figure 1). Diagnosis was variable: 40% ADHD, 12% ASD, 9% behaviour and 9% developmental delay
Green 55: 10 new, 45 follow up.
30 did not request further appointment, 25 requested a further appointment – 24 subsequently attended, 1 DNA for a second time.
Therefore 30 appointments were ‘saved’ – parents did not request further appointments. Before the red, amber, green system was introduced these families would have received another appointment.
Amber 43: 2 new, 41 follow ups.
28 subsequently attended, 15 DNA’d again.
Of these 15, on reclassification:
8 green (5 ADHD, 1 attachment, 1 anxiety, 1 ASD), 1 parent requested a further appointment and 7 did not.
6 amber, (5 had ADHD and 1 sleep difficulties). 4 subsequently DNA again and 2 attended.
1 red (developmental delay). Attended the next appointment.
Red 2 (child protection plans), attended subsequent appointment.
Discussion Out of 100 DNAs 30 appointments were saved as patients classified as green did not request a further appointment. The number of DNAs per year in our department (2011–2012) was 905 of 7320 appointments. Extrapolating further we are potentially saving 271 appointment slots per year (45 clinics) compared to our previous system where all DNAs were automatically offered a further appointment.
Of 43 “amber” children, 28 attended the appointment sent, 15 DNA again. Some were subsequently classified as green, those with ADHD were assumed to be no longer on medication.
The 3 “red” children all attended further appointments.