{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T20:40:09Z","timestamp":1756672809867,"version":"3.44.0"},"reference-count":11,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T00:00:00Z","timestamp":1743379200000},"content-version":"unspecified","delay-in-days":89,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Qual"],"accepted":{"date-parts":[[2025,2,27]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>His Majesty's Prison East Sutton Park is an open prison and young offender institution for women in Maidstone, England. In 2022, it developed a high Did Not Attend (DNA) rate of 21% per week across all five core healthcare clinics. Services with a high DNA rate increase waiting times for other patients, increase cost wastage and reduce efficiency and resource management. DNAs occur across all parts of the National Health Service with different levels of severity; however, DNAs within a prison create a unique challenge not shared with community services due to the setting. This quality improvement project aimed to reduce and sustain a below 10% DNA rate.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The healthcare team worked in partnership with the prison to develop a quality improvement project using the Model for Improvement, which had a clear aim, measures and change ideas tested using Plan-Do-Study-Act cycles. The outcome measures were plotted using Statistical Process Control charts to highlight and track the improvements.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>There was an 86% decrease in DNAs across all five core healthcare clinics. The overall DNA rate was reduced from a pre-intervention rate of 21% per week to 3% per week post-intervention. Clinical time wasted decreased by 76% from a pre-intervention of 284\u2009minutes per week to 66\u2009minutes per week post-intervention. Cost wastage for missed appointments decreased by 67% from a pre-intervention of \u00a3303 per week to \u00a399 per week post-intervention. These core outcome measures have been sustained for more than 35 weeks (August 2023 to April 2024) and continue to be sustained.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Implementing standard processes and systematic change ideas, including developing partnership working with the prison and better engagement with patients, led to a significant and sustained reduction in DNAs. During the project time frame, there was also no change in the number of patient complaints about healthcare.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjoq-2024-003183","type":"journal-article","created":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T02:32:35Z","timestamp":1743474755000},"page":"e003183","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Using quality improvement methodology to reduce Did Not Attends in healthcare within a UK prison"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-2654-588X","authenticated-orcid":false,"given":"Nitish","family":"Lakhman","sequence":"first","affiliation":[{"name":"Oxleas NHS Foundation Trust, Dartford, Kent, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suzan","family":"Harleston","sequence":"additional","affiliation":[{"name":"Oxleas NHS Foundation Trust, Dartford, Kent, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emma","family":"Knight","sequence":"additional","affiliation":[{"name":"Oxleas NHS Foundation Trust, Dartford, Kent, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charlie","family":"Bodnar","sequence":"additional","affiliation":[{"name":"Oxleas NHS Foundation Trust, Dartford, Kent, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Addis","sequence":"additional","affiliation":[{"name":"Oxleas NHS Foundation Trust, Dartford, Kent, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vishal","family":"Bheenick","sequence":"additional","affiliation":[{"name":"Oxleas NHS Foundation Trust, Dartford, Kent, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,3,31]]},"reference":[{"key":"2025083113232650000_14.1.e003183.1","unstructured":"NHS England . Reducing did not attends (dnas) in outpatient services. 2023. Available: https:\/\/www.england.nhs.uk\/long-read\/reducing-did-not-attends-dnas-in-outpatient-services [Accessed 4 Mar 2024]."},{"key":"2025083113232650000_14.1.e003183.2","unstructured":"NHS England . Delivery plan for tackling the covid-19 backlog of elective care. 2022. Available: https:\/\/www.england.nhs.uk\/coronavirus\/publication\/delivery-plan-for-tackling-the-covid-19-backlog-of-elective-care [Accessed 4 Feb 2024]."},{"key":"2025083113232650000_14.1.e003183.3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hsdr02340","article-title":"Targeting the Use of Reminders and Notifications for Uptake by Populations (TURNUP): a systematic review and evidence synthesis","volume":"2","author":"McLean","year":"2014","journal-title":"Health Services and Delivery Research"},{"key":"2025083113232650000_14.1.e003183.4","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0274670","article-title":"A weekday intervention to reduce missed appointments","volume":"17","author":"Ellis","year":"2022","journal-title":"PLoS ONE"},{"key":"2025083113232650000_14.1.e003183.5","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1108\/JHOM-11-2021-0425","article-title":"Causes, impacts and possible mitigation of non-attendance of appointments within the National Health Service: a literature review","volume":"ahead-of-print","author":"Wilson","year":"2022","journal-title":"J Health Organ Manag"},{"key":"2025083113232650000_14.1.e003183.6","unstructured":"NHS England . Missed gp appointments costing nhs millions. 2019. Available: https:\/\/www.england.nhs.uk\/2019\/01\/missed-gp-appointments-costing-nhs-millions [Accessed 20 Feb 2024]."},{"key":"2025083113232650000_14.1.e003183.7","unstructured":"Prisons & Probation Ombudsman . Independent investigation. 2022. Available: https:\/\/s3-eu-west-2.amazonaws.com\/cloud-platform-e218f50a4812967ba1215eaecede923f\/uploads\/sites\/34\/2022\/07\/F5898-21-Death-of-Ms-Jacqueline-Purnell-East-Sutton-Park-24-12-2021-NC-51-60-59.pdf [Accessed 11 Apr 2024]."},{"key":"2025083113232650000_14.1.e003183.8","unstructured":"Langley GJ , Moen RD , Nolan KM , et al . The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. San Francisco, CA: Jossey Bass, 2009."},{"key":"2025083113232650000_14.1.e003183.9","doi-asserted-by":"crossref","DOI":"10.1136\/bmjoq-2017-000093","article-title":"Improving the patient booking service to reduce the number of missed appointments at East London NHS Foundation Trust Community Musculoskeletal Physiotherapy Service","volume":"6","author":"Tan","year":"2017","journal-title":"BMJ Open Qual"},{"key":"2025083113232650000_14.1.e003183.10","doi-asserted-by":"crossref","unstructured":"Masoud T , Shah A , Joomun S , et al . Reducing DNA Rates and Increasing Positive Contacts in an Outpatient Chronic Fatigue Service. BMJ Qual Improv Rep 2017;6. doi:10.1136\/bmjquality.u212876.w5262","DOI":"10.1136\/bmjquality.u212876.w5262"},{"key":"2025083113232650000_14.1.e003183.11","unstructured":"HM Inspectorate of Prisons . Report on an unannounced inspection of hmp\/yoi east sutton park. 2024. Available: https:\/\/hmiprisons.justiceinspectorates.gov.uk\/hmipris_reports\/hmp-yoi-east-sutton-park\/ [Accessed 22 Apr 2024]."}],"container-title":["BMJ Open Quality"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjoq-2024-003183","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T20:23:34Z","timestamp":1756671814000},"score":1,"resource":{"primary":{"URL":"https:\/\/qir.bmj.com\/lookup\/doi\/10.1136\/bmjoq-2024-003183"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":11,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,3,31]]},"published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1136\/bmjoq-2024-003183"],"URL":"https:\/\/doi.org\/10.1136\/bmjoq-2024-003183","relation":{},"ISSN":["2399-6641"],"issn-type":[{"type":"electronic","value":"2399-6641"}],"subject":[],"published":{"date-parts":[[2025,1]]}}}