DNA - Did Not Attend Policy
DID NOT ATTEND (DNA) POLICY
FOR CHILDREN AND ADULTS
1.1 Policy Statement
The purpose of this document is to provide guidance regarding the management of patients who failed to attend their appointments. It is essential to make the best use of the clinicians’ availability to ensure that all patients have access to appointments within an acceptable time frame.
This documents sets out the procedures for monitoring and recording, and the actions to be taken to effectively manage missed appointments at TWHS.
The organisation aims to design and implement policies and procedures that meet the diverse needs of our service and workforce, ensuring that none are placed at a disadvantage over others, in accordance with the Equality Act 2010. Consideration has been given to the impact this policy might have regarding the individual protected characteristics of those to whom it applies.This document and any procedures contained within it are non-contractual and may be modified or withdrawn at any time. For the avoidance of doubt, it does not form part of your contract of employment.
2.1 Statistical Evidence
As well as being costly in financial terms, patients who fail to attend their agreed medical appointments often create excessive waiting times for other patients.
At TWHS during any month, an average of 390 patients are recorded as being a DNA, meaning that the patient neither attended their appointment nor advised the practice within 24 hours prior to the scheduled appointment, to enable a cancellation or change to their appointment to be made.
· An increase in waiting times for patients resulting in the risk of worsening patients’ health
· A waste of the organisation’s time – not simply the clinicians’ time but also that of the administration team as the appointment invariably needs to be rebooked
· Cost to the wider NHS in the requirement of additional clinicians
2.2 Recording DNA’s
All DNAs are to be recorded on in each patient’s healthcare record with the following SNOMED CT codes:
· Did not attend – Reason given – 185326000
· Did not attend – No reason given – 270426007
· Failed Encounter - 185324002
The Reception Manager(s) will review DNA statistics on a monthly basis, presenting this information at team leaders meeting. DNAs are to be displayed, highlighting the facts in the waiting room and on the organisation’s website & social media pages.
It is a practice policy the nature of recording is as follows:
Telephone conversation – Failed Encounter (try 3 times with at least 15 minutes in between) on the last attempt please add the code Did Not Attend.
If this is a person under the age of 16 then you will add the code Child Not Brought.
Face to Face Appointment – Did Not Attend if over 16 and Child Not Brought if under 16.
2.3 Preventative Measures
Almost every primary care organisation has done at least something to try to reduce DNAs. However, the evidence shows that it is usually necessary to do several things and that some of the common approaches need to be adjusted in order to be successful.
In order to reduce the number of DNAs, the organisation will offer:
· Easy cancellation – You can do this via the NHS App
· Appointment reminders - Patients are sent a text message to remind them about a forthcoming appointment. The reminder includes an explanation of how to cancel the appointment if it is no longer wanted.
· Patient engagement – We will ddiscuss the issue with the Patient Participation Group (PPG) to highlight the numbers and plans for improving the DNA rates.
2.4 Managing DNA’s
Should a patient fail to attend their appointment, will enter the fact that the appointment was missed and will record it as either:
Did not attend – No reason given – SNOMED CT 270426007
Did not attend – Reason given – 185326000
Failed Encounter - 185324002
Should a patient advise that they need to cancel an appointment, although less than 2 hours’ notice was given, then the person receiving the call or receiving the notification is to record this as:
Did not attend – Reason given – SNOMED CT 185326000
It should be noted that, whilst unacceptable in most cases, there may be extenuating circumstances as to why the patient failed to attend their appointment. Therefore, prior to any letter being sent to a patient, it would be reasonable to discuss this with their clinician.
Patients that DNA an appointment, should be sent an AccuRx (under the Management Heading) entitled DNA. This will code as Did Not Attend.
2.5 Managing a failed home-visit encounter
A failed visit is where there is no access to or contact with the patient at a planned or agreed visit.
There is often a simple explanation where a patient has forgotten the appointment and has gone out. However a failed visit an also be indicative of a serious incident or issue. Should this occur then further information can be sought in the Home Visit Policy.
2.6 Children who fail to attend
Awareness is to be given to children who fail to attend an appointment.
Whilst all missed appointments have traditionally been classified as a “Did Not Attend”, this group actually needs to be classified as “Was Not Brought” as it is not a child’s responsibility to attend the appointment; it is the responsibility of their parents or carers to take them. As such, awareness must be given to this and the consideration that this could be termed as medical neglect.
2.7 Actions needed for a “was not brought”
Although it is a subtle difference, coding non-attendance of children as “Child not brought to appointment” using the SNOMED CT code 901441000000108 may be considered to enable more accurate safeguarding auditing in addition to emphasising the potential failure by those responsible for the child’s welfare.
It should be noted that not having capacity, nor being able to attend themselves, a child non-attendance should not be classified as a Did Not Attend.
First Missed App
An AccuRx should be sent to the parents of the child under Management in the Templates entitled Child Was Not Brought. This was automatically code them with the correct code. All children should be offered another appointment, you can do this by calling them to offer them a new appointment or using the Self Book Link in AccuRx where you can and is appropriate to do so.
Further missed appointments
Clinician is to contact the parents / guardians to discuss the reason for the missed appointment which must be recorded.
Please forward this patient to the named GP who will assess the patient and can escalate to the safeguarding team after they have tried to make contact or if they have other concerns.
If any clinician have significant concerns, they are to initiate a child protection referral using the practice referral process
Patients who fail to attend their medical appointments continue to have a significant financial impact across the NHS. Having a robust management system in place will help to reduce the number of DNAs TWHS and ensure that all patients have improved access to an appointment within an acceptable time frame.