SMS Text Messaging Improves Outpatient Attendance

By Downer, Sean R.; Meara, John G. et al. | Australian Health Review, August 2006 | Go to article overview

SMS Text Messaging Improves Outpatient Attendance


Downer, Sean R., Meara, John G., Costa, Annette C. Da, Sethuraman, Kannan, Australian Health Review


Abstract

Objective: To evaluate the operational and financial efficacy of sending short message service (SMS) text message reminders to the mobile telephones of patients with scheduled outpatient clinic appointments.

Design: Cohort study with historical control.

Setting: Royal Children's Hospital, Melbourne, Victoria.

Patients: Patients who gave a mobile telephone contact number and were scheduled to attend an outpatient clinic at the Royal Children's Hospital, Melbourne in October, November and December 2004 (trial group) or in October, November and December 2003 (historical control group).

Main outcome measures: Failure-to-attend (FTA) rate compared between the trial group, whose members were sent a reminder, and the historical control group, whose members were not sent a reminder. Financial benefits versus cost of sending reminders.

Results: 22 658 patients with a mobile telephone contact number scheduled to attend an outpatient clinic appointment in October, November and December 2004 were sent an SMS reminder; 20 448 (90.2%) of these patients attended their appointment. The control group included 22 452 patients with a mobile telephone contact number scheduled to attend an appointment, with 18 073 (80.5%) patients attending. The FTA rate was significantly lower in the trial group than in the historical control group (9.8% v 19.5%; P<0.001). The cost of sending the SMS reminders was small compared with the increase in patient revenue and associated benefits generated as a result of improved attendance.

Conclusions: The observed reduction in FTA rate was in line with that found using traditional reminder methods and a prior pilot study using SMS. The FTA reduction coupled with the increase in patient revenue suggests that reminding patients using SMS is a very cost effective approach for improving patient attendance.

Aust Health Rev 2006: 30(3): 389-396

FAILURE TO ATTEND outpatient appointments is a significant and widespread problem in public hospitals that severely reduces the ability to provide an efficient and effective outpatient service. Not only does a high failure to attend (FTA) rate waste clinical and administrative resources, it also reduces revenue opportunities, increases waiting times for outpatient appointments and lengthens treatment times. Traditional reminder methods such as telephone calls and posted letters have high unit costs and require significant staff resources to administer.

In a prior pilot study, short message service (SMS) text messaging was used to remind patients of their outpatient appointment.1 Preliminary findings indicated increased outpatient attendance, lower unit cost than telephone calls or posted letters, and significantly decreased staff resources to administer. These findings suggested that the use of SMS reminders has the potential to be a very efficient and cost effective method to improve outpatient attendance rates. However, in the prior pilot study, the trial was limited to patients with mobile telephone numbers attending only five clinics, which represented about 14% of the total hospital outpatient appointments. Also, the pilot study did not attempt to assess the financial benefits accruing from the increase in patient attendance rate. In the current evaluation, the use of SMS appointment reminders has been extended to include 120 separate outpatient clinics over a 3-month period to assess whether the FTA results achieved in the earlier pilot study could be replicated on a wider scale, and to evaluate the significance of the financial benefit accruing from the resulting improvement in clinic attendance.

Patients and methods

This study took place at the Royal Children's Hospital (RCH) in Melbourne Australia. RCH is a 250-bed hospital which provides tertiary, secondary and primary health services to children and adolescents.

Approval for the study was obtained from the RCH Outpatient Advisory Committee and Chief Executive Officer. …

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