By Jessie Kelly, ARCH Intern

When I was offered a six-week internship with Arch I was asked to produce a White Paper on the impact of SMS reminders on non-attendance rates at hospitals. My first thought was – What on earth is a white paper?! As a recent commerce graduate looking to dip her toe into a different field, I was hardly well-versed in the world of research, or health for that matter. Never one to shy away from a challenge, I set out on my deep-dive of all things SMS reminder related.


Before taking on this project I had no idea of the size of the problem and naively thought that if a person missed their appointment then surely there would be another ten waiting behind her who could take it. How wrong I was. It is perhaps this precise way of thinking that got us here. This is a problem that costs the HSE €33 million per year 1. Our current non-attendance rate is 16%2. We are not alone in this, it is a problem shared by outpatient department across the world. In the UK, media reports suggest missed appointments have cost the NHS as much as £1 billion pounds per year – £162 million for missed GP appointments and £750 million for missed hospital appointments 3.

What I, and so many others, were probably unaware of is the strain it puts on the healthcare system when you fail to attend an appointment. It can be seen in monetary terms – 80 euro per missed appointment to be exact. It can also be seen in wasted use of clinical resources. It can be seen in patient care, or lack thereof, and in waiting times. Some of the most common reasons for non-attendance at appointments include: forgetfulness, resolution of symptoms, competing family and work arrangements, and the fear of being seen by a junior doctor4.

There are other factors contributing to the causes for non-attendance. Subpopulations have been identified as particularly at risk for non-attendance in many studies. Those suffering from mental health problems are less likely to show up at appointments, and those who suffer drug and alcohol addictions. For these patient groups, non-attendance could indicate a decline in the mental health and an increase in drug and alcohol use5. Therefore, a simple SMS reminder may not be the best approach and something more personal should be considered instead. Interestingly, the wording of the reminder can have an impact on whether a patient attends an appointment or not. A research trial carried out with Barts NHS Trust found that phrasing your message in a way that appeals to a patient’s empathy will get a higher attendance rate. In this study, they included the exact cost of the missed appointment and urged patients to consider others who were waiting for appointments and the affect it would have on them6.

While SMS reminder systems may not be appropriate for every patient-group, they have been shown to provide a solution to the problem at a more general level. They offer a non-invasive, discrete and convenient way to reach patients. They are also relatively inexpensive compared to the cost of phone-calls or letters being that there is little labour involved.

Appointment systems are often employed with the objective of increasing attendance rates, without much thought given to cancelling or rescheduling the appointment7. What has become apparent to me in the short time I have spent researching this, is that the SMS reminder should allow the patient to respond to cancel or reschedule the appointment. It would be far more useful and efficient to do so. One study found that patients who received a reminder were more likely to cancel their appointment and in doing so, allowed the hospital to reschedule up to 40% of the cancelled appointments8.

We live in a time where we are connected and reachable 24/7. Data from Comreg show that in Ireland we have more mobile phone subscriptions than people9. Now is the time to bring our processes in hospitals up to speed with the way we all live our lives. It is evident by the sheer cost of this that something needs to be implemented to improve the situation. In outpatient departments that have trialed the SMS messaging reminders, increases in attendance of at least 10% have been recorded. This would lead to substantial savings for the HSE and benefits for the public in return.



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