A telephone call reminder to improve outpatient attendance in patients referred from the emergency department: a randomised controlled trial

Background: Poor compliance with attendance at outpatient clinic appointmen ts in patients referred from emergency departments (EDs) is a major problem in public hospitals. Aims: To determine whether the intervention of a telephone call within thre e days of ED attendance would improve: 1. the proportion of patients making recommended outpatient appointments; and 2. the proportion of patients att ending scheduled appointments. To characterise reasons for non-attendance a t appointments made by patients referred from the ED. Methods: A randomised controlled trial was undertaken of 400 patients recom mended to make outpatient appointments during attendance at The Royal Melbo urne Hospital ED in July-August 1999. Intervention: a telephone call one to three days after attendance to remind the patient about the appointment (a nd its importance for medical follow-up) if one had been made and to offer to make an appointment if one had not been made. Outcome measures: 1. makin g the recommended appointment; 2. attendance at the scheduled appointment; and 3. reasons for non-attendance at scheduled appointments. Results: The telephone intervention improved attendance at scheduled appoin tments from 54.4% to 70.7% (p=0.002). The proportion of patients making app ointments was not significantly affected. The commonest reasons given for n on-attendance were: attended general practitioner (13%), attended private s pecialist (6.6%), inpatient in hospital at time of appointment (6.6%), too busy or inconvenient (5.3%), claimed to have attended (5.3%) and did not di ffer by intervention. Conclusions: A significant improvement in the proportion of patients attend ing outpatients appointments can be made by a simple reminder telephone cal l one to three days after attendance at the ED.