Text stating £160 cost to NHS per missed appointment could cut non-attendance and save it £
millions
Media release from the University of Warwick
As many as 400,000 missed hospital appointments a year could be prevented simply by using wellworded warning texts, potentially saving the NHS £64 million.
A new study based on one NHS Trust practice found ‘Did Not Attend’ (DNA) rates could be reduced
by 5,800 - or as much as 28,900 if the Trust had a record of every patient’s mobile number - simply
by making reference to the £160 cost the NHS incurs from each missed appointment.
And assuming the NHS has just 20 per cent of patients’ mobile numbers it would reduce DNAs by
400,000, potentially saving the taxpayer an estimated £64 million.
Healthcare providers are increasingly using SMS reminders to reduce DNA rates with statistics
showing in 2012–13 around 5.5 million NHS outpatient appointments were missed in England (9.3
per cent of the total). A recent estimate claims missed first outpatient appointments cost the NHS up
to £225 million in 2012–13.
The research Stating Appointment Costs in SMS Reminders Reduces Missed Hospital Appointments:
Findings from Two Randomised Controlled Trials by Ivo Vlaev, Professor of Behavioural Science at
Warwick Business School, Michael Hallsworth, Michael Sanders and Anna Sallis, of the Behavioural
Insights Team, Dominic King and Ara Darzi, of Imperial College London, and Dan Berry, of the UK’s
Department of Health, is the first to show evidence of the impact of the content in texts sent to
patients.
Professor Vlaev said: “Moving from the existing text reminder to the more effective message
emphasising the cost of missing an appointment would result in 5,800 fewer missed appointments
per year at the NHS Trust in question, at no additional cost.
“On the same basis, full phone record coverage could result in 28,900 fewer missed appointments
for the Trust annually.
“These results show that the wording of SMS reminders significantly affects the extent to which
patients miss, attend or cancel outpatient appointments.
“Moreover, the results show that presenting the specific tariff cost of the appointment produces a
DNA rate that is approximately three percent lower than for other messages, a result that we
replicated across two trials. Telling a patient the cost their missed appointment has on the NHS
therefore genuinely persuades some to reconsider.”
The research involved two trials analysing outpatients with a valid mobile telephone number and an
appointment. The first involved 10,111 patients between November 2013 and January 2014 and the
second, between March and May 2014, was tested on 9,848 participants. They were randomly sent
one of four reminder messages, which were issued five days in advance.
These outpatients were one of five specialities: rheumatology, ophthalmology, gastroenterology,
neurology, and cardiology. These specialities were chosen because they were not currently the
subject of any other initiatives to reduce DNAs, apart from the SMS reminders already in use
In the first trial, a message including the cost of a missed appointment to the health system
produced a DNA rate of 8.4 per cent, compared to 11.1 per cent for the existing message.
DNA
Percentage
Message
Wording
Existing message
(control)
Appt at [clinic] on [date] at [time]. To cancel or rearrange call the
11.1%
number on your appointment letter
Easy Call
Appt at [clinic] on [date] at [time]. To cancel or rearrange call
02077673200
9.8%
Social Norms
We are expecting you at [clinic] on [date] at [time]. 9 out of 10
people attend. Call 02077673200 if you need to cancel or
rearrange
10.0%
Specific Costs
We are expecting you at [clinic] on [date] at [time]. Not attending
costs NHS £160 aprox. Call 02077673200 if you need to cancel or 8.4%
rearrange
The second trial replicated this effect with a DNA rate 8.2 per cent, but also found that expressing
the cost implications in general terms without mentioning the exact amount was significantly less
effective with a DNA rate of 9.9 per cent.
DNA
Percentage
Message
Wording
Specific Costs
(control)
We are expecting you at [clinic] on [date] at [time]. Not attending
costs NHS £160 aprox. Call 02077673200 if you need to cancel or 8.2%
rearrange
General Costs
We are expecting you at [clinic] on [date] at [time]. Not attending
wastes NHS money. Call 02077673200 if you need to cancel or
9.9%
rearrange
Empathy
We are expecting you at [clinic] on [date] at [time]. Please be fair
to others waiting and call 02077673200 if you need to cancel or 10.7%
rearrange.
Recording
We are expecting you at [clinic] on [date] at [time]. Please attend
or call 02077673200 to cancel/rearrange, or we will record as a 9.6%
missed appt.
“The fact that there were no significant differences between the ‘control’ and ‘social norms’
messages means we can be confident that the effect of the ‘specific costs’ message is not being
driven by the ‘we are expecting you’ message framing, or the presence of the telephone number,”
added Professor Vlaev.
“In crude terms, this comparison suggests that the content of SMS reminders may constitute a large
part of their overall effect. The more general implication is that health system performance
improvements do not depend on technical solutions alone.”