Reminders generate annual savings of £1.3 million & reduce DNA’s to 7.8%

The issue

Before working with Healthcare Communications, East Sussex relied solely on Interactive Voice Message to remind all patients of upcoming appointments. The service was fragmented across specialities and patient mobile phone capture was low. Key contributing factors also included:

  • Some appointments are booked well in advance, increasing the chance of a patient forgetting the appointment all together
  • An ageing Trust demographic. 25% of East Sussex’s population are 65+ and the county has one of the highest number of over 75’s in the country
  • Patients did not realise that if they notify the hospital that they could not attend, the slot could then be offered to another patient


Healthcare Communications worked with East Sussex to understand their patient groups and provide a solution for each blocker to a lower DNA rate. With only 40% of patient mobile data, it became clear why ‘the one size fits all’ strategy was not working. Instead an integrated approach was implemented to remind patients by communication preference in the most cost efficient way.

Successful strategy

1. Patient forgets appointment

There can be up to 5 weeks between a referral and a patient’s appointment. For this reason, forgetfulness is the main reason why a patient DNA. To overcome this, the following call plan was deployed:

      • A two way SMS reminder is sent 7 days prior to the patient’s appointment with the opportunity to respond with CANCEL or REBOOK
      • If the mobile details are incorrect or the Trust has landline only details, an IVM automatically follows providing rebook and cancel options too

2. Full coverage by adding Agent calls

Agent calls are a key element to East Sussex’s success. In October 2015, live agent calls were introduced to:

      • Remind patients over 70 years of age about their appointment
      • For the small percentage of reminders that don’t reach patients by SMS or IVM, an agent call automatically follows
      • IVM hang up: When a patient picks up an IVM call but hangs up without listening to the message. An agent will call the number knowing that someone is available for the reminder

In march 2016, Agent calls:

      • Confirmed 4905 patient appointments
      • Contacted 53 patients who were unaware they had an appointment. This equates to additional monthly income of approximately £8480
      • Cancelled 106 appointments and rearranged 160, opening up 266 slots for reuse

3. Consistent communication

In November 2015, East Sussex introduced 24 hour ‘gentle’ one way reminders sent by SMS and IVM. By doing so, missed appointments reduced by from 9.4% to 8.1%.

4. Real time reporting

Envoy software captures responses and produces daily automated reports on rebooks, cancels and other responses to action as per patient requests. Envoy also enables the trust to measure departments on a weekly basis and review areas where DNA’s are higher than expected.

Results to date

  • New appointment DNA’s dropped from 10% a year ago to 7.8%
  • Follow up appointment DNA’s reduced from 9.8% to 6.9%
  • Increased income of potentially £1.3 million based on £120 per appointment
  • A reduction of approximately 8,000 missed appointments from September 2015 – May 2016
  • More intelligence as to why the Trust experiences DNA’s enabling greater insight and improved planning
  • Improved patient experience which links to improved RTT performance

In summary

East Sussex now remind 89% of patients about upcoming appointments. The intelligent communication plan means the most cost effective channel is attempted first and automatically switches to the next channel if connection is not made.

The new objective is to further improve DNA’s to rank in the top quartile of the UK and capture more patient mobile details to increase cost efficiencies.

East Sussex are now targeting specific high DNA patient groups such as Pediatrics and looking at using agent calls to lower missed attendance.