Introduction High ‘did not attend’ rates have a huge impact on precious NHS resources. Paediatric DNAs add another dimension to this problem: the safety of the unseen child.

Aim The overall aim of this quality improvement project is to reduce missed patient appointments in community paediatric outpatient clinic without jeopardising the welfare of vulnerable children.

Methods The project was rolled out in three phases

Phase 1: Patient did not attend (DNA) trends were obtained from the Trusts’ information analyst and systematically analysed for patterns and trends over a one year period from August 2014 to August 2015. In addition to this, a short survey of 30 patients who did not attend was completed by clinic nurses and clerical staff over 2 month period.

Phase 2: This involved developing standard outpatient appointment and DNA letters taking into consideration the safeguarding implications of non- attedances, text message reminders, developing DNA posters for outpatient clinic waiting areas as a way of educating patients on the impact of DNA on NHS and the Trust.

Phase 3: Evaluating and reviewing the impact of these interventions on DNA rates

Results DNA trends: Average rate of non- attendance in community clinics is 24%. However, troughs and peaks in activity are not uncommon. Non attendance rates can be as high as 38% during school holidays, 35% for looked after children clinics and 40% for school clinics.

Outcome of DNA survey: 30% of patients did not attend due to administrative errors: Not receiving appointment letters; receiving text messages instructing them to do to the wrong site. In 15% of cases patient forgot about appointment. In 10% of cases the cause is varied: Child was unwell; parents tried to ring to rebook but could not get through; it was the first day of school.

Patient DNA posters were developed and approved by patient information services after patient consultation.

Conclusion Patients are not always to be blamed for non attendance. Clinicians working closely with management and clerical staff to reduce administrative errors, together with patient education and using simple cost effective technology for clinic reminders can be effective in reducing non attendance rates and improving patient experience.