Missed hospital appointments cost €22m - could have paid for 1,000 extra staff

Missed outpatient appointments possibly wasted €22m of health service money last year, new figures from one of the country’s largest hospitals have shown.

The chief executive of the Cork University Hospital (CUH) group, Tony McNamara, said the so-called ‘do not attends’ (DNAs) created a “significant waste of scarce resources” which could have financed 1,000 clerical or administrative staff.

He called for a public-awareness campaign to stress to people the value of outpatient appointments, and the knock-on cost of not attending them.

“There will always be a certain amount of missed appointments — things come up at the last minute and people just can’t make them, for one reason or another. That’s life,” he said.

“But people ring up to cancel hair appointments or dinner reservations. I think if people realised the cost to the system of outpatient appointments, they would think twice about just not turning up.”

Last year, at CUH, 26,000 of 242,000 appointments went unfulfilled — that’s a DNA rate of 12%. Each DNA costs CUH €44, arising from the retrieval of medical notes by administrative staff, the review of referral/patient notes by a consultant, a record being made in the notes to the effect that the patient did not attend, letters being sent to GPs and patients informing them of outcome, and the re-filing of medical notes.

DNAs in CUH last year wasted €1.5m, which Mr McNamara said was the equivalent of pay for 50 clerical staff (while other patients lost out on appointments wasted by DNAs).

Waiting lists are reviewed to ensure that every patient on the list still requires an appointment, but despite many patients confirming that they still want to be seen by a consultant, Mr McNamara said they often still do not attend.

“It is quite incredible that even in relation to cancer clinic appointments, a DNA rate of 7% is evident over time, with opportunities foregone to allocate those appointments to other patients who are suspected of having cancer,” he said.

The national figures are even more staggering, with 488,000 people failing to attend the estimated 3.3m new and return appointments issued to patients at other, acute hospital outpatient departments last year — that’s a DNA rate of 15%.

Based on the average, €44 DNA cost in CUH, the national cost of appointment no-shows might be as high as €22m.

“One can only imagine how much added value could be added to patient care, if the system was able to achieve even a 50% reduction in the national DNA rate to 7.5%,” he said.

“There is also a need for a more informed debate, by commentators, on the staggering numbers of patients seen in our outpatient departments and, rather than focussing solely on waiting-list numbers, a more nuanced commentary might be to explain to the public the need to advise these departments, in advance, if they do not intend keeping an appointment, so that the appointment can be given to somebody else, thereby enabling clinics to function more efficiently.”

But Mr McNamara said outsourcing outpatient appointments to private hospitals was not the way forward.

He said a simple phone call, from people who don’t intend keeping hospital appointments, would allow the slots to be given to other patients, would achieve significant savings, and would be more efficient.


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