Significant issues identified by patients included:
- Not knowing what to expect at their appointment
- Frustration around waiting times and appointment cancellation
- Difficulty contacting Radiology
- Information regarding parking and public transport
- Information not getting to patients in a timely way, not being able to fill recently vacant appointment slots at short notice
- Patient attending appointments not appropriately prepared
- Pain
Patient appointment letters have traditionally been poorly formatted leading to difficulties in finding relevant information such as "nil by mouth" instructions.
Although text messages can be a useful way of reminding patients of appointments [2, 3] and are sent out by our department to remind patients of appointments, they are limited to 160 characters. We planned to improve the quality of information delivered to patients' mobile phones by utilising the fact that they are connected to the internet (in 2017 there were 3.8 million mobile phones with active internet connections in NZ [4]).
There were two main components to the improved information delivery:
1. Appointment letters:
Patient appointment letters were redesigned to make key information more accessible and legible, using logos and text boxes in addition to unformatted plain text (Figure 3).
2. Digital delivery of reminders and information:
We considered various options for improving the digital delivery of and access and opted for a text message-based system which embeds a hyperlink in the SMS. It does not require an app to be installed and is compatible with all smartphones. includes information about the procedure, requirements for preparation and travel and parking advice.
A custom smartphone app was considered but feedback from patients suggested that they were unlikely to download the app and many did not use many apps on their smartphone, but did use their phones to access the internet.
Apps also have a considerable overhead for the department as they need to be developed for Apple iOS and Android and maintained to work with the frequent operasting system updates. The mechanism we chose has the advantages of not needing patients to download an app, not requiring apps to be updated and being compatible with any internett browser (Figure 4).
Reminder messages can be sent at appropriate intervals tailored to the procedure and the preparation required.
The new letters, text messages and web pages were tested with 15 patients who reported that they preferred the new formats and found the information to be useful. We are currently measuring the effect on the changes on attendance, cancellation and abandonment rates (commencing August 2019).