SMS Appointment Reminder System Improving Waiting Times

Impact of an electronic SMS appointment reminder system on waiting times at a large publicly funded sexual health centre

South Eastern Sydney Illawarra Area Health Service

Abstract

In 2006 it was noticed that the wait time to the next available appointment was increasing at Sydney Sexual Health Centre (SSHC). It was proposed that longer wait time would result in an increased non-attendance rate. A review at the time showed the mean non-attendance rate for appointments for each of the nursing, medical and counselling units was 22%, 21% and 12% respectively.

In an attempt to address this problem, as these rates were deemed unacceptable, the Data Manager at SSHC developed an interactive electronic appointment system with inbuilt SMS appointment reminder system.

A post implementation review showed the mean non-attendance rate decreased by almost half for the medical and nursing units. Similarly, the wait time for a booked appointment reduced substantially for all the units.

Aim

To decrease waiting times for appointments at a large publicly funded sexual health service through implementation of an electronic SMS appointment reminder system that is built into an interactive appointment booking program.

Nature of the Problem

At SSHC, patients can be seen either by appointment or through a drop in service. Clinicians see a patient with an appointment and then are rostered to see a patient who attended without an appointment. Patients are triaged throughout the day to drop in and vacant appointment spaces.

In 2006 it was noticed that the number of days until the next available appointment or waiting times for appointments were increasing at SSHC. It was proposed that longer wait time would result in an increased non-attendance rate. There was also anecdotal evidence that the nursing unit had a high non-attendance rate.

Extent of the Problem

Increasing prevalence of sexually transmissible infections in Australia as well as limited resources has led publicly funded sexual health services to look at the efficiency of their services. Having patients not attending for appointments may be a waste of scarce resources, if a walk in patient is not available to be seen.  SSHC triages all new and return patients requesting appointments and this has made the appointment system more efficient in seeing those most at risk, however, it has not had an impact on non-attendance rates.

The literature states that long lead time to appointments is the single most important factor in high non-attendance rates especially with certain groups of patients such as young people.

Each day Nurses calculated the number of days to the next available booked appointment for each of the Counselling, Medical and Nursing units.  At the end of each day they calculated the number of patients who did not attend for each of the units.

Strategic Importance

The NSW HIV/AIDS and STI strategies - 2006-2009, clearly articulate that a priority issue is prioritising access to and focus of publicly funded sexual health clinics.  They designate 5 priority populations. SESIAHS HIV/AIDS and STI strategies directs this process at an area health level and the Area has set up a working group to progress prioritisation and access as decreed by the National and State strategies. In order to ensure that people from priority populations are seen, SSHC needs to be certain its appointment system is efficient and not an impediment to working at capacity. 

Planning and Implementing Solutions

In 2006 a review of wait times and appointment non-attendance rates showed an overall non-attendance rate of 16.3%. This is on target and indeed lower than most non-attendance rates in other outpatient clinics and other sexual health services. Recommendations from this review stated the added costs of using a manual telephone reminder system was not supported because the rate was so low, and it recommended implementation of an electronic system.

As no commercial products were available that could be supported on the Area network, the SSHC Data Manager designed an electronic booking system whereby clinical staff can make appointments for their patients in their clinical room. They can also see the patients waiting in what is known as a virtual waiting room. Once the patient has an appointment made the inbuilt SMS reminder system automatically sends them an appointment reminder the day before their appointment. The patient is prompted in the reminder to call and cancel their appointment if they cannot make it.

Prior to implementation, a quality improvement survey was conducted at SSHC asking patients their preferred contact method. Overwhelmingly patients noted email and mobile phone as the preferred contact method.

Concerns re informed consent for contact and privacy issues were brought up by clinical staff during the development phase. To address this a system was put into place whereby the triage nurse informs all appointments that a SMS reminder system is in place and asks the patient to consent and opt into this system.

The interactive appointment booking system is compatible with both the Area Health Service and in-house computer programs and systems.

Outcomes and Evaluation

Prior to implementation of the interactive appointment booking system, the longest wait time for a book appointment was for a nursing unit appointment where the median wait time was 7 days and the longest wait was 12 days. The counselling unit had the shortest wait time, with same day appointments available in most cases. The longest wait was two days. The medical unit median wait time was 2 days. The longest wait was 6 days.

After the interactive appointment booking system was implemented the waiting times review was repeated. This showed that longest wait time for a book appointment was once again for a nursing unit appointment but the median wait time had reduced from 7 to 5 days with the longest wait reducing from 12 to 7 days. The counselling unit wait times were unchanged. The medical unit median wait time had also decreased from 2 to 1 day and the longest wait was down from 6 to 2 days.

Similarly, improvements in did not arrive numbers were also seen post implementation. The mean percentage of patients who did not arrive for appointments dropped from 21% to 12% for doctors and from 22% to 14 for nurses. 

Sustaining Change

The interactive appointment booking system with inbuilt SMS reminder is now fully integrated into clinical care at SSHC.  The Centre is committed to data management support for the system to ensure it continues as an integral part of patient care.

All patients are informed when making an appointment that the reminder will be sent, unless they opt out of this. Ongoing review of the system and its impact on efficiency of services at SSHC will be undertaken to ensure the improvements and patient acceptability seen to date are sustained over time.

Future Scope

The interactive appointment booking system with inbuilt SMS reminder could be utilised by any service that has an information technology platform that utilises SQL databases.  It could also be taken up by NSW and used throughout all outpatient and community health areas.

SSHC is also utilizing the SMS reminder system to recall patients needing review or follow-up. Examples of this include priority population patients requiring screening for STIs at designated intervals and clients undergoing vaccination schedules. SMS reminders are being sent to them alerting them to the need for follow-up appointments.

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