J R Soc Med 2002;95:448-449
doi:10.1258/jrsm.95.9.448
© 2002 Royal Society of Medicine
Influence of a nurse practitioner on non-attendance rate for barium enema
Michael Scott BMedSci MRCS
Sian Allen MB ChB
Alasdair Bamford MA MBBS
Maria Walshe RGN
Celia Ingham Clark MChir FRCS
Whittington Hospital, London N19 5NF, UK
Correspondence to: Michael Scott E-mail:
mikescott{at}doctors.org.uk
 |
SUMMARY
|
|---|
Non-attendance for barium enema investigation wastes resources,
prolongs
waiting times and delays diagnosis of colorectal carcinoma.
In an inner-city
hospital with a previous non-attendance rate
of over 20% for barium enema we
investigated the value of systematic
personal contact with a nurse
practitioner at the time of booking.
We compared two groups of patients, all
of whom received an
explanation of the procedure from the referring clinician.
Patients
referred from the colorectal clinic were accompanied by the
colorectal
nurse practitioner to the radiology department for booking,
an
appointment being sent later by mail. The nurse practitioner
reiterated the
details of the procedure, provided supplementary
information, confirmed the
patient's contact details and provided
a telephone number in case further
information or assistance
was needed. Patients referred from the
gastroenterology clinic
were managed as previously, making their own way to
the radiology
department and receiving supplementary information only on
request.
The patients referred from the two clinics were closely similar; however,
the non-attendance rate for the intervention (colorectal) clinic was 4/157
(2.5%) compared with 17/110 (15.5%) for the comparison clinic
(P<0.001). A year previously the non-attendance rates in these
clinics had been 23% and 20%, respectively.
These results indicate that personal contact, with supplementary
information, can substantially reduce the non-attendance rate for barium
enema.
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INTRODUCTION
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The tendency of patients not to keep appointments applies not
only to
outpatient clinics but also to planned investigations.
Non-attendance rates
vary between regions and specialties and
are sometimes as high as
34%
1. Non-attendance
is influenced
by patient gender, age, length of waiting time for the
appointment
and
deprivation
2,3.
For certain investigations, such as barium
enema, non-attendance not only
wastes resources but can also
delay the diagnosis of malignant disease. In our
inner-city
hospital, anecdotal evidence suggested that the high non-attendance
rate
for barium enema was attributable partly to clerical errors
and partly to
fear of the investigation or the result. It was
proposed that the introduction
of personal contact combined
with supplementary advice might improve rates of
attendance.
|
PATIENTS AND METHODS
|
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As previously, all patients in whom a barium enema was requested
received
an explanation of the procedure by the requesting clinician.
Patients from the
gastroenterology clinic then took the request
form directly to the radiology
department. Subsequently, by
mail, they received an appointment date and bowel
preparation
material, along with directions for its use. Patients from the
colorectal
clinic followed the same procedure but were accompanied from
the
clinic to the radiology department by the colorectal nurse
practitioner. She
reiterated the explanation of the procedure
and of bowel preparation and
provided each patient with supplementary
written information. She also
confirmed the patient's contact
details and provided her telephone number so
that further information
or assistance could easily be obtained. Written
information
regarding barium enema investigation was available to all patients
but
only actively given to patients from the colorectal clinic.
The non-attendance rate following this intervention was compared directly
with that in a contemporary control group of patients from the
gastroenterology clinic. The symptoms prompting investigation were identical
in the two groups. Non-attendance rates for the previous year were ascertained
for the two clinics and for all outpatient clinics (to ensure that no global
changes were underway). The reasons for non-attendance were sought by
telephone.
Non-attendance rates were expressed as percentage of total booked requests.
Statistical analysis was by 
2 test.
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RESULTS
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The non-attendance rate for the colorectal clinic patients
post-intervention
was 4/157 (2.5%) compared with 17/110 (15.5%) for the
control
clinic (
P<0.001). Equivalent figures for the previous year
were
23% and 20%, respectively. Of the 81 non-attenders in the contemporary
and
historical group, 68 were contactable by telephone and the reasons
for
non-attendance are illustrated in
Table
1. Overall hospital
outpatient non-attendance rates were 18.7%
during the study
period and 19.7% during the previous financial year.
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DISCUSSION
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This study shows that the simple measures of providing increased
patient
information and a personal contact within the hospital
substantially improved
non-attendance rates for barium enema
investigations with both financial and
practical benefits. Previous
studies have attributed over a quarter of
non-attendance to
simple clerical
errors
4 and in our
study 17/49 non-attenders
(35%) contacted before the intervention stated that
the reason
they had not attended was non-receipt of an appointment. The
true
figure may be even higher since 13 patients were not contactable
at the
telephone numbers held on either hospital or general-practitioners'
computer
databases. Patient computer records are frequently
inaccurate. Contact details
were checked by the colorectal nurse
practitioner.
Patients also cited fear of both the investigation and the possible result
as reasons for non-attendance. Explanation of the barium enema investigation,
and the possible findings and outcomes, is often difficult to achieve
satisfactorily in the busy outpatient department. Communication problems are
compounded by the fact that our local patient population has an unusually
diverse cultural background and uses many different languages. Patient
information leaflets, along with the opportunity to discuss the investigation
further at leisure with the nurse practitioner, can be expected to lessen
non-attendance from this cause. Ours is not the first study to show that
personal contact combined with increased information reduces non-attendance
rates5,6.
The increased demand placed upon the colorectal nurse practitioner was the
main resource change in this study. Printed information leaflets were already
widely available. The cost of supporting this increase in duty is likely to be
offset by the savings in terms of wasted time in the radiology department and
also efforts to arrange further investigations or follow-up.
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SUMMARY
INTRODUCTION
