We created an effective, transferable process for Doncaster and Bassetlaw Teaching Hospitals to address rising paediatric ophthalmology ‘did not attend’ rates, resulting in a significant improvement.

Background

In response to the continued operational pressures in elective care and following the success of the national 100-day challenges, NHS England commissioned NHS Midlands and Lancashire’s Improvement Unit to deliver a wave of rapid improvement challenges across the North Region. We supported Doncaster and Bassetlaw Teaching Hospitals (DBTH) to utilise the 100-day challenge methodology to reduce ‘did not attend’ (DNA) rates for paediatric ophthalmology. ​

Children ‘not brought’ to their hospital outpatient appointments are a specific concern because:​

• their health may be compromised​.
• additional financial and waiting time burdens are placed on the respective services​.
• non-attendance at appointments is potentially an indicator of a child’s overall wellbeing and care – a recurring feature in many serious case reviews. ​
• clinicians must spend considerable time arranging subsequent appointments and following any required safeguarding processes.​

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Action

We: ​

• gained baseline data for ophthalmic paediatric DNAs within DBTH​.
• modelled all current processes involved from point of referral to appointment, determining and implementing front-end interventions to encourage and facilitate attendance​.
• reviewed final data​.
• produced a business case to transfer administrative duties from clinical staff to an appointed paediatric ophthalmology pastoral welfare officer.​

Impact

Paediatric ophthalmology DNA rates reduced by 4.3 per cent with DNA rate for follow-up appointments down by 9.1 per cent in one month. ​

​A robust DNA administration process was created to ensure a coherent approach to the management of children not brought to paediatric ophthalmology appointments.​

The process is entirely transferable and scalable, locally, regionally and nationally. ​

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