07DNA Management

Purpose

Handling missed appointments safely - confirming the patient was properly reminded, offering a rebook, and assessing clinical risk before anyone is discharged.

RAG rating

Set by Lauren at referral triage, based on the risk and urgency of the patient.

Once first contact has been attempted, all three ratings follow the same process, letters and timings.

Procedure

1. Add the patient to the DNA tab with RAG rating, DOB, name and date of the DNA.
2. Check and record that the patient did receive their reminders - the ad-hoc booking reminder and the automated Semble reminders - before treating the DNA as the patient's failure.
3. Send the 1st DNA letter. The patient must phone in to rebook; there is no online booking.
4. Record whether the patient rebooks.
5. Record the outcome of the rebooked appointment. If they attend, filter out.
6. If they DNA a second time, send the 2nd DNA letter and record the date of the second non-attendance.
7. Take the case to the Daily Brief to assess whether there is any clinical risk in discharging.
8. The Daily Brief decides: offer a further appointment, or discharge per pathway (C5).

Fields recorded

RAG rating · DOB · name · date of DNA · ad-hoc booking reminder sent · Semble reminders sent · DNA letter sent · rebooked (Y/N) · outcome of rebooked appointment · 2nd DNA letter · date of 2nd non-attendance · Daily Brief outcome · next steps

Notes

• The reminder check exists so a patient is never penalised for a DNA when the service did not remind them.
• DNAs are recorded at the morning meeting and coded as outcome code 3 for the ICB (26).

Open points

• Whether a DNA is billable to the ICB.

Flowchart