How patient engagement tools are reducing DNAs in Diagnostics

When it comes to digital transformation across the NHS, diagnostic services, who despite playing an integral role in the patient pathway, often remain grounded in outdated, traditional ways of working. This is further complicated by the complexity of diagnostic pathways, with multiple systems and touch points across primary, secondary, and community care.

By introducing simple, yet powerful patient engagement solutions, diagnostic services can transform the way they operate and tackle their biggest challenges, including high DNA (Did Not Attend) rates and resource constraints.

We've already seen Trusts make meaningful strides towards delivering these impacts. The role of patient engagement in The Royal Orthopaedic Hospital NHS Foundation Trust (ROH)'s diagnostic services became the key to combating their pressing problem: high DNA rates.

ROH were facing DNA rates as high as 7.4%, exceeding the national benchmark, with MRI-specific non-attendance ranging from 10-16%. With DrDoctor, ROH successfully reduced its overall radiology DNA rate to an impressive 3%, including a reduction of over 80% for MRI—in just three months.

The problem of missed appointments in diagnostics

Diagnostic services play a critical role in informing subsequent treatments and follow-ups. At ROH, initial imaging appointments were crucial in shaping the patient’s care journey. However, high DNA rates significantly disrupted patient pathways. This not only wasted scarce resources but also increased the likelihood of missed or unproductive follow-ups.

The specialised nature of diagnostics further amplified the knock-on effect. The average cost of a no-show outpatient appointment is approximately £120, but this figure is considerably higher in radiology: upwards of £160. The equipment and skills required for these procedures make the cost of DNAs substantially higher than in other areas of care.

Additionally, unattended imaging appointments often result in a heavy manual workload as booking teams are left with taking precious admin time spent on the phone trying to call patients to reschedule, adding to the waiting list backlog.

Recognising these issues, ROH implemented a patient engagement solution tailored to the unique demands of diagnostic procedures, addressing the inefficiencies of their existing outreach and communication efforts that lacked the engagement needed for operational optimisation.

Personalised and timely engagement: The key to success

Care teams have been working tirelessly to combat high DNA rates in diagnostics by manually phoning patients, moving away from the costly and inefficient practice of sending letters by post. While these methods are a step in the right direction, they add further burden on staff, who must manage a high volume of inbound and outbound calls. Given the scale of the challenge, these resource-intensive manual efforts are not a sustainable long-term solution. 

Digital engagement tools offer a more effective approach by automating and personalising communications, ensuring patients receive all necessary details specific to their upcoming appointment(s). By automating high-value, low-complexity actions, Trusts can free up their valuable and costly human resources to focus on more impactful areas of care, ultimately enhancing overall efficiency and quality.

The right information…

Providing the right information involves sending tailored messages based on each patient’s specific needs. Generic reminders, although beneficial, often fall short for complex diagnostic procedures. Personalised messages should include specific guidance, such as fasting instructions, jewellery removal, or bladder preparation, to ensure appointments proceed smoothly and avoid rescheduling due to a lack of preparation. Information should be surfaced in the format that best suits each patient—via SMS, email, paper letter, or directly in the NHS App—to ensure accessibility, convenience, and ultimately reducing DNAs.

The right time…

Timing is equally critical. Patients scheduled for multiple scans should receive a consolidated reminder that outlines the details of each scan. An intelligent messaging system can prevent overwhelming patients with multiple notifications for appointments on the same day. ROH utilised automated SMS reminders sent 7 and 2 days ahead of appointments, along with immediate confirmation messages when appointments were booked, cancelled, or rescheduled. Other tools such as Direct Messaging can open up a two-way line of communication so teams can reach patients quickly to fill last-minute diagnostic appointments.

The right place…

Hospitals can be disorienting and intimidating, so clear communication on instructions and proper signposting help patients arrive on time and fully prepared. Appointment management such as Scheduling empower patients to make changes or cancellations if needed, improving attendance rates. This proactive approach allows staff to reuse and book slots that become available in advance, optimising the scheduling process and reducing wasted resources. 

Overcoming integration challenges in diagnostics  

The benefits of patient engagement tools are undeniable, but their effectiveness can hinge of the interoperability of multiple systems. This, in turn, relies heavily on the technology in place. Specialised departments, such as radiology, often use unique platforms like Radiology Information Systems (RIS) such as CRIS or Soliton, which differ from Electronic Patient Records (EPRs) and Patient Administration Systems (PAS) more common place in other areas such as Outpatients.

These differences are often overlooked during broader digital transformations, leading to compatibility issues that can hinder the implementation of new engagement tools and slow down operational innovation in diagnostics. To overcome these roadblocks, Trusts must choose agnostic platforms that integrate seamlessly with the systems their team know and use everyday.

What can diagnostic services learn from ROH?

ROH's experience demonstrates the transformative power of personalised patient engagement in diagnostics. As a result of implementing these improvements, other diagnostic departments can replicate this success and expect:

• Combat the ever-present problem of DNAs: With the introduction of foundational patient engagement tools, ROH successfully reduced its overall radiology DNA rate to an impressive 3% from 7.4% - in just a matter of months.
• Progress towards meeting critical NHSE standards: Ensuring patients attend their diagnostic appointments is vital for maintaining the flow of care and meeting key NHS England (NHSE) standards. Patient engagement tools can help diagnostic departments maintain compliance with these performance metrics. ROH's experience illustrates this, achieving a 10% improvement in the 28-Day Faster Diagnosis Standard and reaching 99% adherence to the 6-week referral-to-diagnosis standard within three months.
• Cost savings: Reducing no-shows directly impacts a trust's financial health. For ROH, lowering the DNA rate for both Radiology and MRI resulted in estimated annual cost-avoidance savings of over £216,000.
• Operational time savings: Through SMS reminders and basic rescheduling, ROH saved 35 admin hours within three months, which translates to 140 hours annually. This operational efficiency enables diagnostic departments to better allocate their limited time and resources.
• Enhanced patient satisfaction: Over 90% of patients at ROH rated their experience as good or excellent, reflecting the positive impact of improved communication on the patient experience. High satisfaction rates reduce complaints, concerns and enhance a Trust’s reputation. 

Laying the foundations for digital transformation in diagnostics 

ROH’s engagement strategy for diagnostics has delivered measurable improvements, showcasing how simple, yet effective patient engagement tools can make a massive impact. These solutions—focused on reducing DNAs and improving patient communication—bring clear returns on investment (ROI) by saving time, increasing productivity, and lowering costs.

By starting with these straightforward, yet powerful tools—such as SMS reminders, direct messaging, and basic rescheduling—diagnostic departments can address immediate challenges while laying the blueprints for long-term digital transformation.

Looking to the future, this layered approach to implementing patient engagement can compound its impact over time. By building on these foundations, diagnostic services can further simplify pathways for a smarter, more productive and better-connected NHS.