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LETTERS: Prince Cheriyan Modayil, Rachael Hornigold, Raad John Glore, and David A Bowdler Patients’ attendance at clinics is worse with choose and book BMJ 2009; 338: b396 [Full text]

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Choose and book fails to improve patient attendance in orthopaedic clinics.

Thomas B. Beckingsale, Ian W. Wallace   (4 March 2009)

Choose and book fails to improve patient attendance in orthopaedic clinics. 4 March 2009
Thomas B. Beckingsale, 3rd year SpR, Orthopaedic Surgery. James Cook University Hospital, Middlesbrough. TS4 3BW., Ian W. Wallace Send response to journal: Re: Choose and book fails to improve patient attendance in orthopaedic clinics.	Sir, we read with interest the pilot study of Modayil et al. (BMJ 2009;338:b396) and have evidence of a similar decline in patient attendance in our own clinics since the instigation of choose and book.1 Choose and book went fully online for elective Orthopaedic referrals to the James Cook University Hospital, Middlesbrough, in October 2006. We audited the attendance rates of all new patient elective referrals to orthopaedics for 2005 and 2008, to assess the effect of choose and book. In 2005 before the initiation of choose and book in our department, there were 3144 elective referrals to Orthopaedic outpatients, of which 170 did not attend (5.41%). In 2008, a year after choose and book had been established, the number of elective referrals rose to 3961, but the number of non- attendances rose proportionally more to 349 (8.81%). The noted rise of non - attendances from 5.41% in 2005 to 8.81% in 2008 is statistically extremely significant (2x2 chi squared = 29.49 [Yates corrected]. P=0.0000001) and equates to a 39% rise in non-attendance rates after the commencement of choose and book. This significant rise in non-attendance rates inevitably reduces the cost-efficiency and productivity of the department. Despite the raison d’être of choose and book, patients complain of a lack of choice regarding appointment date, appointment time, and hospital availability.2 GPs bemoan the system’s inflexibility and the inability to refer specific problems to suitable sub-specialists.3,4 Hospital doctors lament the change to patient prioritisation with its negative effects on workload and patient care.5 In Orthopaedics, referral to, and triage by, extended scope physiotherapists adds an extra layer to the process of obtaining specialist review, resulting in unnecessary delays in treatment, frustration amongst GPs and their patients, and a significant increase in non-attendance rates. 1. Modayil PC, Hornigold R, Glore RJ, Bowdler DA. Patients' attendance at clinics is worse with choose and book. BMJ 2009;338:b396. 2. Green J, McDowall Z, Potts H. Does Choose & Book fail to deliver the expected choice to patients? A survey of patients' experience of outpatient appointment booking. BMC Medical Informatics and Decision Making 2008;8(1):36. 3. Midgley AK. "Choose and book" does not solve any problems. BMJ 2005;331(7511):294-b-. 4. Pothier D, Awad Z, Tierney P. "Choose and Book" in ENT: the GP perspective. The Journal of Laryngology & Otology. 2006;120(03):222- 225. 5. Pothier DD, Repanos C, Awad Z. How we do it: Analysing GP referral priorities: the unforeseen effect of Choose and Book. Clinical Otolaryngology 2006;31:327-330. Competing interests: None declared