Monday blues explain why patients miss hospital and GP appointments

Significant health and financial savings could be achieved by changing when hospital outpatient and GP appointments are scheduled, say researchers from the University of Glasgow's School of Psychology.

Approximately 12 per cent of all outpatient appointments at UK hospitals are not kept, costing the health system an estimated £600 million a year.

Consequently even a small reduction in the percentage of missed appointments could save the NHS significant sums, write psychologists Dr Rob Jenkins and David Ellis in the online journal PLoS One.

"If you could cut non-attendance by just a tenth – from 12 per cent to 10.8 per cent, you could save the NHS £60 million a year," says Dr Jenkins. "It would also improve patients' health and reduce the risk of illness."

The researchers studied two sets of data.

First they analysed the attendance records for 4,538,294 outpatient hospital appointments across Scotland between 1 January 2008 and 31 December 2010. Next they examined the attendance records for 10,895 appointments at a single GP clinic in Glasgow.

"Our analysis of both sets of data shows that more appointments are missed at the start of the week than at the end of the week," Dr Jenkins explains. "Mondays are worst for missed appointments. But over the course of the week attendance steadily improves. Fridays have the fewest no-shows."

Adds David Ellis: "Although the causes of non-attendance aren't well understood, we believe significant health and financial savings could be achieved very easily and cheaply by scheduling appointments towards the end of the week, rather than at the start of the week.

"Interestingly, however, we found that hospitals tend to do the opposite - they load appointments at the start of the week."

The pattern of declining non-attendance rates matches the pattern seen in emotional responses to weekday cues, leading the researchers to speculate that medical appointments may be harder for patients to face on some weekdays than on others.

"Recent psychological studies have shown that different days of the week evoke distinct emotional responses," continues Dr Jenkins. "Mondays have the most negative response; Fridays the most positive. And emotional tone brightens steadily over the intervening days.

"Missed appointments seem to follow the psychological peaks and troughs of the weekly cycle, with emotionally positive days boosting patient resilience and improving attendance.

"This interpretation chimes with many of the psychological reasons patients give for missing their appointments: fear of bad news; fear of unpleasant treatment; or even negative relationships with medical staff."

And David Ellis concludes: "Our study clearly shows that appointments at the beginning of the week are missed more often than those at the end of the week.

"A simple strategy for reducing missed appointments could be to schedule appointments towards the end of the week wherever possible."