Nearly half a million outpatient appointments were missed last year

St James’s Hospital has one of the highest no-show rates nationally, figures show

Nearly half a million hospital outpatient appointments were missed last year, while more than 125,000 appointments were unattended in the first three months of this year.

Statistics from the Health Service Executive, granted in response to requests from The Irish Times, reveal that there are major variations in the "don't show" figures from different hospitals.

Nearly one-fifth of patients failed to turn up for outpatient appointments at Mayo University Hospital last year, while Limerick University Hospital had the best record, with just seven per cent no-shows.

Nearly 1,300 people a day fail to attend outpatient appointments nationally, which creates major issues for the HSE, hospitals and consultants as they struggle to cut waiting lists.


In total, more than 476,000 DNAs (do not attends) were logged last year.

Large numbers missed genito-urinary medicine appointments, related to the treatment and prevention of sexually transmitted infections (19.7 per cent), and psychiatry appointments (18 per cent).

A spokeswoman for the Mayo hospital said it acknowledged the DNA rate was high. The hospital is looking at using text messaging, which has been proven to lower non-attendance rates. It is also considering improving the referral system to avoid multiple referrals at the same time.

It is claimed that some GPs go “appointment shopping” because of lengthy waiting lists, and refer the same patient to several hospitals to get the patient seen as soon as possible.

Text reminders

St James’s Hospital, Dublin – the country’s largest hospital – has one of the highest DNA rates (17 per cent) nationally. A hospital representative said “hospital policy in relation to removing a patient from the waiting list after a DNA varies across speciality and referral condition”.

A HSE spokeswoman said patients were asked to let their hospital know as soon as possible if they could not attend scheduled appointments so that other patients could be offered the appointments.

“Hospitals continue to focus on ensuring that communication with patients regarding their appointment dates is effective with both written communication and text-messaging services used to remind patients of their appointment dates,” the spokeswoman said. Not all clinics provide text messaging services, however.

Referral queries

The HSE is developing a business case for a new digital care pathway system to help improve waiting lists for outpatient, inpatient, day case and diagnostic appointments.

The system envisages using algorithms to determine what specialty is required, instead of a GP solely making a decision where to refer.

The system would allow GPs to request advice on where best to refer a patient. Rather than all patients being put on the one waiting list, some could be referred to an advanced nurse practitioner, community team, primary care centre, or small hospital.

A new pathway for urology appointments within the Saolta Hospital Group in the west has been piloted and others are planned.

Under HSE policy if a person fails to attend they are then given a second appointment. If they do not turn up for the second slot, they are taken off the waiting list. No penalties are issued for non-attendance.

Other countries operate what are known as “partial booking” systems, which allow patients choose their appointment date. This system is in operation within the Saolta Hospital Group for certain specialties.