This document summarizes an audit of follow-up procedures for pediatric dental patients who failed to attend appointments at a hospital. The audit found that while protocols were in place, not all no-show patients received appropriate follow-up, posing a risk to children's health and safety. A second audit after implementing new pathways showed improvement, but the goal of 100% follow-up was still not met. The authors conclude that failed appointments represent an ongoing challenge and risk to children due to lack of dental care and potential safeguarding issues.

1. An audit of follow up procedures for
patients failing to attend appointments
in the Paediatric Department
Susan Parekh & Adele Johnson

2. Background
• Failure to attend dental appointment (DNA):
• May have a negative impact on child health
• Raise safeguarding issues and concerns
• Waste of the NHS resources

3. Dental neglect – impact
• Severe pain
• Loss of sleep
• Time off school
• Interference with playing and socialization
• Damage to underlying permanent teeth
• Can affect body weight / growth
• Reduced quality of life

4. Background
• Locally – UCLH, any DNA – letter to GMP
• Nationally
• Serious case reviews

5. At Eastman Dental Hospital (EDH):
Type of appointment Protocol in place
1. New patient DNA letter (ECRA) – outcome?
2. Treatment / follow up No clear pathway, clinicians vary:
• Contact pt
• Send new appointment
• Send a DNA letter, asking to contact &
book a new appointment
• Discharge
3. General anaesthesia • Parents telephoned day before
• First DNA, re-book
• If the patient DNA’s for a second time,
taken off the waiting list & given a review
appointment with the consultant

6. Aims & Objectives
1. To identify current systems in place for paediatric
dental patients who DNA in the three main groups;
a) New patient
b) Treatment/follow up
c) GA
2. Establish robust procedures / pathways to ensure that
all patients who DNA are followed up appropriately

7. Gold Standard
100% of DNA’s are followed up

8. Materials & methods
• Retrospective audit
• Three groups (New, treatment/follow-up, GA)
• Data source - patient notes & electronic data
Cycle 1:
Six months (Jan – July 2010)
Cycle 2:
Six months (Jan – July 2012)

9. Results – cycle 1
New patients
(NP)
Follow up
(FU)
General
Anaesthesia (GA)
TOTAL
Number of
pt DNA
136 (18%) 575 (77%) 43 (5%) 754

10. Patients with no outcome of DNA according
to group
In total 89 / 754 (11%) - no action taken after DNA,
5 children safeguarding issues

11. Action Plan - DNA outcome pathways developed

12. Results – cycle 2
New patients
(NP)
Follow up
(FU)
General
Anaesthesia (GA)
TOTAL
Number of
pt DNA
166 (20%) 676 (79%) 9 (1%) 851
DNA
without
outcome
8 (4%) 69 (10%) 0 77 (9% of
total DNA)

13. Discussion
• Gold standard of 100% DNAs followed up not met
• DNA not followed up reduced from 11% to 9%
• DNA with safeguarding issues decreased
(cycle 1, n=5) to (cycle 2, n = 0)
• Number of DNA’s increased in cycle 2 (but not
identical population size in both cycles)
• Majority were for follow up appointments –
consequence of DNA?

14. Discussion
• Number of patients with safeguarding issues
increasing generally (but followed up)
• All DNA patients discharged from department -
letter copied to GMP
• Trust guidance for DNA – telephone family

15. Action plan
• Reception staff to call day before sedation
appointment
• Appointments made too far in advance (now
book only 6 weeks ahead)
• Difficulties accessing reception to rebook
(introducing dedicated call centre for patients)
• Text reminders
• Re-audit in 2014 (cycle 3 ongoing)

16. Conclusion
• Challenge of DNA’s
• Unmet standard of 100%
• KNOWN RISK TO CHILD