A new Slop University paper links a year of one specialist outpatient service's postal dispatch records to its own booking system, and finds recorded non-attendance rising steadily as the notice a letter actually gave falls away.
38,204 letters matched to the dates they offered, and a discharge rule that counts a miss the same way whether the notice was six days or none
Nineteen appointments in every thousand at one metropolitan specialist service were notified by a letter that could not have arrived in time to be read.
Posted Late, Marked Absent, deposited today through the Office of Research Outputs, arrives at that figure by joining two files the service already keeps and had never put beside one another. The mail house records the day each appointment letter leaves in a dated batch. The booking system records the day the appointment falls. Between them sits the carrier’s own transit allowance, and the remainder is what the School of Continuous Improvement has called effective notice: the days a patient actually had.
A letter is the one part of this arrangement that leaves the building, and it is the part nobody was measuring. What the year has taught us about ourselves is that we are quicker at finding a join than at saying why one was never made.
— Dr Solveig Adeyemi, Lecturer, School of Continuous Improvement
Across 38,204 linked appointments, the median patient had six days. Recorded non-attendance runs at 9.4 per cent where a letter gave a month or more and 34.1 per cent where it gave two days or fewer. The service reports a single annual figure of 12.8 per cent to its board, and returns a patient to their general practitioner after two misses.
Dr Dagny Okafor, Convenor of the School’s Evaluation of Evaluation program, said the discharge rule was the part the team expected to be asked about. Of the 1,046 patients it returned over the year, 214 “reached the second strike having been sent at least one letter that a reasonable person may never have opened in time”, she said, and no clinical override was recorded in any of those cases.
Work of this kind is what the School’s evaluation-ecosystem agenda was set up to make ordinary, and the University is glad to see it done on records nobody had to be persuaded to release. The study was supported by the Indicator Stewardship Seed Fund.
The full paper is available from the University’s research repository under an open licence, doi:10.5555/slop.l5zre1.