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National

Dashboard > Outpatient Appointment DNA


 

DNA % 7.94
Opportunity £68,283,108
Volume Opportunity 651,014
Rank 1

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Treatment Function DNA % Financial Opportunity Volume Opportunity Rank
Ophthalmology 7.94 £4,271,786 48,085 1
Trauma & Orthopaedics 8.13 £4,064,706 40,352 1
Cardiology 7.74 £3,424,567 24,658 1
Obstetrics 6.76 £2,924,431 29,208 1
Physiotherapy 9.22 £2,538,017 34,445 1
Paediatrics 11.08 £2,530,260 14,522 1
Urology 8.01 £2,197,398 15,263 1
Gynaecology 7.71 £2,166,208 16,892 1
Dermatology 7.78 £2,060,619 22,118 1
Respiratory Medicine (Thoracic Medicine) 10.38 £2,025,377 14,532 1
Rheumatology 8.46 £2,018,221 15,457 1
Gastroenterology 11.24 £1,954,745 13,809 1
Ear, Nose & Throat (ENT) 9.43 £1,869,648 19,158 1
Clinical Haematology 6.63 £1,858,960 12,356 1
Midwife episode 5.35 £1,684,936 26,789 1
General Medicine 7.04 £1,565,541 10,911 1
Neurology 9.83 £1,517,751 12,166 1
General Surgery 7.58 £1,410,847 11,693 1
Breast Surgery 6.23 £1,387,757 9,462 1
Diabetic Medicine 11.73 £1,203,488 10,502 1
Nephrology 7.88 £1,060,656 6,863 1
Clinical Oncology (previously Radiotherapy) 2.98 £1,030,511 8,706 1
Oral Surgery 10.92 £918,587 8,594 1
Anticoagulant Service 7.78 £916,982 20,731 1
Colorectal Surgery 8.48 £838,425 7,585 1
Pain Management 10.38 £808,866 6,605 1
Geriatric Medicine 9.35 £788,583 4,321 1
Respiratory Physiology 10.20 £779,491 4,296 1
Maxillo Facial Surgery 10.77 £768,022 7,735 1
Vascular Surgery 8.72 £760,599 5,554 1
Infectious Diseases 14.80 £732,385 3,156 1
Medical Oncology 3.78 £718,640 6,026 1
Plastic Surgery 8.53 £709,256 7,824 1
Paediatric Dentistry 13.21 £708,434 4,741 1
Endocrinology 11.30 £688,214 5,647 1
Clinical Physiology 6.21 £657,249 4,741 1
Restorative Dentistry 8.58 £606,500 5,387 1
Paediatric Ophthalmology 14.27 £575,337 5,535 1
Orthodontics 8.32 £534,773 4,451 1
Orthoptics 13.00 £387,942 4,709 1
Hepatology 14.38 £385,299 2,980 1
Diagnostic Imaging 0.96 £384,822 8,321 1
Audiology 5.42 £326,667 4,334 1
Paediatric Trauma and Orthopaedics 9.78 £303,849 2,446 1
Transient Ischaemic Attack 4.81 £277,833 922 1
Anaesthetics 5.65 £266,498 3,697 1
Dental Medicine Specialties 9.14 £256,537 2,071 1
Clinical Neurophysiology 7.57 £248,007 1,976 1
Accident & Emergency (A&E) 10.88 £245,387 6,645 1
Gynaecological Oncology 6.53 £238,756 1,813 1
Occupational Therapy 7.03 £235,475 4,134 1
Paediatric Cardiology 7.96 £226,106 1,200 1
Podiatry 6.35 £210,273 4,283 1
Dietetics 9.96 £208,137 5,297 1
Audiological Medicine 6.57 £200,909 2,197 1
Paediatric Endocrinology 10.51 £195,489 825 1
Paediatric Respiratory Medicine 11.96 £191,538 1,064 1
Paediatric Gastroenterology 11.94 £188,215 1,038 1
Paediatric Surgery 11.24 £185,974 1,314 1
Paediatric Ear Nose and Throat 10.97 £180,748 1,974 1
Paediatric Clinical Haematology 8.21 £179,248 747 1
Paediatric Urology 12.48 £178,910 1,137 1
Paediatric Dermatology 12.35 £177,454 1,602 1
Upper Gastrointestinal Surgery 8.54 £169,031 1,611 1
Neurosurgery 7.46 £164,288 1,775 1
Medical Ophthalmology 9.21 £155,300 1,364 1
Cardiac Rehabilitation 8.56 £152,493 1,914 1
Interventional Radiology 3.82 £151,305 688 1
Spinal Surgery Service 7.71 £147,186 1,210 1
Hepatobiliary & Pancreatic Surgery 8.47 £134,258 901 1
Paediatric Diabetic Medicine 9.81 £122,147 1,205 1
Cardiothoracic Surgery 5.84 £119,494 574 1
Paediatric Clinical Immunology and Allergy 11.75 £109,327 806 1
Cardiac Surgery 5.65 £106,378 494 1
Thoracic Surgery 6.96 £100,283 496 1
Paediatric Plastic Surgery 8.82 £95,497 829 1
Burns Care 6.97 £87,822 818 1
Allergy 12.47 £80,632 797 1
Orthotics 8.01 £76,870 2,103 1
Paediatric Epilepsy 12.15 £70,880 399 1
Neonatology 9.40 £70,375 1,614 1
Community Paediatrics 11.14 £66,961 2,379 1
Paediatric Audiological Medicine 12.59 £63,747 996 1
Paediatric Nephrology 8.58 £55,400 696 1
Clinical Psychology 9.38 £51,961 1,382 1
Paediatric Maxillo-facial Surgery 11.25 £49,522 727 1
Clinical Genetics 9.12 £48,930 644 1
Paediatric Medical Oncology 4.55 £48,297 522 1
Clinical Immunology & Allergy 11.27 £44,907 459 1
Chemical Pathology 13.27 £44,005 1,219 1
Optometry 9.09 £42,355 501 1
Rehabilitation 9.16 £40,939 2,785 1
Clinical Pharmacology 6.55 £40,857 280 1
Transplantation Surgery 8.04 £39,473 1,037 1
Programmed Pulmonary Rehabilitation 14.22 £37,794 1,056 1
Paediatric Neurology 10.02 £36,096 876 1
Nuclear Medicine 5.03 £34,968 463 1
Speech and Language Therapy 5.21 £33,420 1,147 1
Stroke Medicine 13.51 £33,005 1,126 1
Paediatric Neuro-disability 10.79 £32,213 810 1
Clinical Immunology 11.41 £25,729 429 1
Spinal Injuries 8.16 £24,252 165 1
Paediatric Burns Care 7.83 £15,147 503 1
Paediatric Rheumatology 8.76 £12,814 423 1
Congenital Heart Disease Service 12.98 £10,743 138 1
Sport and Exercise Medicine 6.76 £9,915 175 1
Prosthetics 5.62 £9,204 287 1
Genitourinary Medicine 3.88 £8,310 2,476 1
Bone & Marrow Transplantation 2.17 £8,072 113 1
Paediatric Neurosurgery 7.25 £4,847 433 1
Palliative Medicine 2.73 £4,443 627 1
Critical Care Medicine 16.98 £3,763 125 1
Paediatric Metabolic Disease 8.41 £3,744 305 1
Paediatric Intensive Care 8.93 £3,120 31 1
Haemophilia 15.32 £2,824 722 1
Cardiothoracic Transplantation 3.11 £2,081 48 1
Paediatric Cardiac Surgery 4.55 £449 15 1
Clinical Microbiology 3.34 £163 19 1
Addiction Services 40.57 - 170 1
Adult Cystic Fibrosis 11.81 - 615 1
Adult Mental Illness 11.89 - 842 1
Child & Adolescent Psychiatry 12.17 - 3,349 1
Eating Disorders 6.53 - 98 1
Forensic Psychiatry 50.00 - 0 1
Intermediate Care 7.54 - 290 1
Learning Disability (previously MH) 1.68 - 32 1
Liaison Psychiatry 8.05 - 232 1
Medical Virology 1.35 - 14 1
Non-UK Provider; specialty function not known, treatment mainly medical - - 0 1
Non-UK Provider; specialty function not known, treatment mainly surgical 13.54 - 0 1
Old Age Psychiatry 4.86 - 323 1
Paediatric Cystic Fibrosis 5.18 - 242 1
Paediatric Gastrointestinal Surgery 66.67 - 1 1
Paediatric Infectious Diseases 15.96 - 106 1
Paediatric Interventional Radiology 8.31 - 26 1
Paediatric Pain Management 5.91 - 33 1
Paediatric Thoracic Surgery 6.10 - 20 1
Paediatric Transplantation Surgery 10.99 - 0 1
Perinatal Psychiatry 43.38 - 0 1
Psychotherapy 7.37 - 410 1
Respite Care 100.00 - 0 1
Tropical Medicine 1.22 - 25 1
Well Babies 4.89 - 335 1

DNAs have an enormous impact on the healthcare system in terms of cost and waiting time, significantly adding to delays along the patient pathway. Reducing the number of patient non-attendances can not only improve the efficiency of running a clinic, but can also save money.

This indicator measures the number of outpatient appointments where the patient ‘Did Not Attend’ against the total number of outpatient appointments. This includes Consultant, Nurse, Midwife, and other Care Professionals attendances, including Ward Attendances for nursing care.

Key steps :

  • Analyse your DNA rates to identify where these are out of line with the expected levels
  • Make sure the appointment is necessary. Reducing the number of inappropriate follow-ups not only frees up time, it also reduces the number of patients who do not attend because they feel the appointment is unnecessary.
  • Reduce patient anxiety by ensuring that they know what is going to happen and when; clear information is the key e.g. thorough pre-operative assessment• Reduce patient anxiety by ensuring that they know what is going to happen and when; clear information is the key e.g. thorough pre-operative assessment.
  • Appointment cards/letters should be easy to read and understand. Aim for consistency of style by consulting receptionists, booking clerks, nurses and doctors. Consider re-designing your appointment letters and cards and canvas a cross section of patients on a range of designs.
  • Provide a clear and easy contact point for patients to cancel and re-book appointments.
  • Send reminders to patients, especially in specialties with high rates of non-attendance or for patients who receive appointments a long time in advance. Text messages are a useful way of sending reminders from three weeks to one day before an appointment (This may be more useful for some groups of patients than others).
  • Ensure that appointments are made at a convenient time for both the patient and the hospital.

Further Information

NHS Elect – Service Transformation Tools

http://www.nhselect.nhs.uk/Service-Transformation

Information Shown

This indicator shows the financial productivity opportunity to be realised by reducing the excess DNA’s that could have instead been spent on patient care. This measure allows trusts to compare their DNA rates with the national distribution. A high level of DNA’s indicates a system that might be making unnecessary appointments or failing to communicate clearly with patients. Potential saving is defined as the excess DNA’s (based on the selected percentile for each treatment function) per quarter multiplied by the Payments by Results (PbR) tariff. The potential saving is an indicator of opportunity cost – the amount that could have instead been spent on patient care. Organisation Dashboard The following information is displayed for managing DNA appointments. DNA% - Percentage rate for the trust or treatment function Financial Opportunity - The financial opportunity based on the quarter performance. Multiply by 4 to calculate annualised opportunity. Volume Opportunity - Potential adjustment in attendance Rank - Rank calculation based on DNA% within combinations of organisation type or Treatment Function and quarter of data

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