Greenwich Assessment and Shared Care Team: Mobile Phone SMS to reduce DNAs

The Use of Mobile Phone Text Messaging to remind Patients of Appointments

Implementation Guidance for Trust Wide Launch: October 2009

A project to be given to the lead administrator in each directorate will first of all involve the following: for a survey to be conducted identifying the levels of mobile phone ownership (see appendix 1 for tool used in the Trust Inpatient Survey of 2007). This should ideally involve clients on both enhanced and standard care, in receipt of outpatient services in Oxleas.

Ensure that all client mobile phone numbers are entered in the correct format. Number should be free of illegal characters such as dashes, spaces or letters. The mobile number will be stored in the mobile phone field only, and must start with the pre fix 07. It must be ensured that only the clients mobile number is entered here.

Clients to be contacted regarding plans to implement a text message reminder service. This could be done in the form of posters placed in all open reception areas of outpatient clinics (See appendix 2 for poster used to highlight plans for implementation) OR via direct verbal communication with clients on attendance to clinics. The poster must contain a number/ area (e.g. reception) to be contacted if clients DO NOT wish to receive such reminders. Client IDs of those opting out from the reminder service will be sent to the Head of ICT (Tristan David). On launch of the service, a bulk text will be sent to all clients, informing them of the service launch; this will contain a service number which clients are to ring if they wish to opt out from the service. In ASC, clients were given the direct line number of the project lead, which also had a voicemail on it, upon which clients could leave messages in the event of absence. Alternatively, they may be given the main reception number.

Note, there will be an increase in the number of calls coming to reception at the start of the project, though this is not expected to last beyond a few weeks of the launch. Again, the named lead for the project will be required to send IDs of those opting out to Tristan, who will keep a log of the opt out numbers, not to receive text message reminders. This list will be managed by IT Sector solutions who will ensure that the system does not select such numbers.

There must be a consistent communication with staff and colleagues regarding the weekly DNAs. Posters were placed in the reception area at ASC every Friday afternoon, following calculation of that weeks DNA rates (See appendix 3; a poster which was amended with the weekly rates).

Step 5: To ensure that efficient use of existing resources is maintained. Keep a log of cancellations (appendix 4). As clients will be sent a reminder a 7 and 2 days pre-clinic appointment, the aim (of the 7 day reminder) is to ensure that clients cancel in time for the appointment slot to be utilised for either crisis or outpatient appointments; whilst the 2 day reminder will serve a purely reminder purpose.

When clients do DNA, contact must be made (whether by clinician or project lead) to ascertain reason for non attendance (see appendix 5). This should guide future interventions if greater knowledge regarding the reasons for non attendances among psychiatric outpatients in Oxleas is made.

For clients who DO NOT have a mobile number, provisions should be made to use other assertive reminder techniques. These could include a phone call to a land line number, a letter to clients address, or perhaps handing clients an appointment card on departure from clinic. Plan is not to exclude clients from any sort of reminder, and to ensure DNAs are kept to a minimum, and managed effectively.

Plan

These 7 steps should make for a better response to the long term management of DNAs. Senior management to ensure that admin and all other staff are entering patient data in the correct format as stated in step 2, and that regular contact is made with Tristan David regarding IDs for opt out, and any technical queries.

The admin lead forBexley and Bromley (Liz Pitt or Zaki Mossa) will require an NHSmail account (which is an NHS.net account). I currently hold an account for Greenwich, but IT will then create an account for these persons as the identified leads for each directorate.

Any queries, to be passed on to: Harpreet Sanghara in the Greenwich IAPT service.

Appendix 1: Service User Mobile Phone Survey Tool

Use of SMS for Relapse Prevention in Psychosis: Survey of Current Inpatients

Section A – Demographic Data
Sex: / M/F / Income: / Y/N
Age: / Benefits: / Y/N
Ethnic group: / DLA / Y/N
In employment: / Y/N / Income Support / Y/N
Section B – Questions
Can you read and understand English? / Y/N
Do you have a mobile telephone? / Y/N
Can you use the text messaging service? / Y/N
Would you mind the hospital contacting you weekly on your mobile phone by text to see how you are doing? / Y/N
Would you be prepared to text back to the hospital the answers to up to five questions every week? / Y/N
If no to the above, what can we do to make you change your mind? Please tick
below
I don’t want any contact with the hospital
I prefer face-to-face contact
I cannot afford the cost of text messaging
I don’t have a mobile phone
Other:
Section C – Clinical Data
Diagnosis:
Duration of illness (months)
(Note: date of onset of illness required)
Last admission date:
Number of previous admissions:

Note: all demographic and clinical data were gathered from case records and electronic files
Appendix 2: Poster regarding implementation plans of SMS

Appendix 3: Weekly DNA communication; this was edited to contain the weekly DNA percentage

Appendix 4: Cancellation Log Sheet

RIO ID / Date of Call / Time of Call / Original appointment date and time / Reason for cancellation / Appointment re-scheduled / Appointment slot filled/ patient attended

Appendix 5: DNA log Sheet

RIO ID / Date of DNA / Reason for DNA / Action Taken

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Harpreet Sanghara: Project Lead