Intended for healthcare professionals

Education And Debate Quality improvement report

Information given to patients before appointments and its effect on non-attendance rate

BMJ 2001; 323 doi: (Published 01 December 2001) Cite this as: BMJ 2001;323:1298
  1. K J Hardy (kev.hardy{at}, consultant physician and endocrinologist,
  2. S V O'Brien, diabetes nurse specialist,
  3. N J Furlong, clinical research fellow
  1. Diabetes Centre, Whiston Hospital, Prescot, Merseyside L35 5DR
  1. Correspondence to: K J Hardy
  • Accepted 23 July 2001


Problem: Wasted outpatient appointments as a result of clinic non-attendance, exacerbating outpatient waiting times.

Design: Single centre, prospective, non-randomised, controlled study.

Background and setting: Diabetes clinic in a district general hospital run by a consultant, one or two diabetes nurse specialists, a dietitian, and a podiatrist. Clinic receives 10–15 new referrals a week in a health district with a population of 340 000.

Key measure for improvement: Non-attendance rate in 325 new patients who attended after the intervention compared with 1336 historical controls from the same clinic in the three years before the scheme.

Strategy for change: Two weeks before their outpatient appointment new patients were sent an information pack telling them when and where to come, where to park, what to bring, who they will see, and what to expect. One week before the appointment they received a supplementary phone call.

Effects of change: Telling patients what to expect reduced non-attendance rate overall from 15% (201/1336) to 4.6% (15/325), P<0.0001. Non-attendance rate was 7.3% (13/178) in those sent a pack but not phoned and 1.4% (2/147) in those sent a pack and phoned, P=0.01.

Lesson learnt: Giving new patients detailed information reduces non-attendance to almost 1%.


  • Funding None.

  • Competing interests None declared.

  • Accepted 23 July 2001
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