DNA versus Cancellation - should there be a standard metric?

Earlier in the week, we asked you on Twitter, ‘Should there be a national standard for what constitutes a Did Not Attend (DNA) versus a cancellation?’and it evoked some conversation.

The debate began in our office when we realised that if a patient calls on the day of their appointment and cancels, some Trusts will count this as a cancellation and some as a DNA. As insignificant as this may seem, this results in a huge discrepancy in the DNA rates of Trusts across the country.

For example, Hospital A might report a DNA rate of 6% and Hospital B may report a DNA rate of 9.8%, but they may have the same clinical utilisation. So in many cases, there is a huge unmeasured and unexplored productivity opportunity.

In fact, as the chart below shows, most cancellations are within 2 days of the appointment. Of those within 24 hours of the appointment date, 70% go unfilled.

A DNA is more than just a financial drain

The only major benefit of a cancellation vs a DNA is that the clinician doesn’t have to wait around, and can actively spend their time working on something else. Beyond that, perhaps last minute cancellations should be much of a muchness with a DNA.

A DNA costs trusts around £90 - £140. For most acute hospitals, this is a multimillion pound problem and according to the NHS Information Centre there is a productivity opportunity of over £600 million based on average tariff by specialty by Trust.

And there’s more bad news about DNAs – patients who DNA are 40% more likely to present in A&E within the next 7 days, and one in 50 outpatients who miss an appointment fail to attend three or more further appointments within three months.

There is one important difference..

So why does it matter how we categorise these, if either way the slot doesn’t get used? Well, in the case of cancellations, technology can come to our aid to refill slots quickly and automatically.

When a last-minute cancellation occurs, some clever automation can offer the slot to a pool of patients, giving them the option to be seen sooner. The patient can choose to take the slot; reducing wait times and increasing clinic utilisation. Once accepted, their original appointment becomes free and that spot will then be automatically offered out to a pool of patients and the cycle continues. This allows clinics to run much closer to the capacity they were designed for.

Cancellations no longer go to waste and the automated systems can also reduce time on the phone by 50%. Reducing time spent cancelling and rebooking patients can be a huge cost saving measure.

Do we standardise DNAs?

So the question remains; should there be a standard definition for what makes cancellation and what makes a DNA, and does it matter? We think so!

With many important decisions resting on the back of metrics like these, it's vital we see some consistency across the board. If business cases are based off of them and a patients views on the hospital too, important values like these need to come from a place of clarity and accuracy.