6170 Was not brought: current practice & opportunities to intervene

Objectives When children and young people (CYP) were not brought (WNB) to an outpatient appointment there is financial losses and increase to waiting times but also potential safeguarding concern. CYP are reliant on a responsible adult to attend health appointments and missed appointments are a theme in many Safeguarding Practice Reviews, often an early indicator of abuse or neglect. This retrospective review evaluated WNB practice in our Paediatric Outpatient department to identify opportunities for earlier intervention. Methods Using our Electronic Patient Record system, we extracted data on paediatric outpatient appointments in one calendar week in May 2023. We analysed those data, evaluating the prevalence of WNB by specialty, type of appointments, outcome and follow up. Results Of 810 appointments booked, 72 (8.9%) WNB. Paediatric subspecialties that had a higher WNB rate than average included allergy dietetics & nursing, respiratory, adolescent physiotherapy, surgery, infectious disease, psychology, diabetes and urology. The mean and median age of CYP who WNB (13.2 and 15 years, respectively) indicates that patients who do not attend the appointments tend to be older. Three quarters of WNB were follow up appointments, and nearly 80% were face to face. In 18% of cases the clinician attempted to contact patient's carers to investigate the reason for not attending the appointment. In nearly half of cases, a further appointment was offered while for nearly 30% of encounters the appointment outcome was not recorded, with a risk of losing these patients to follow up. One patient was already known to Children Social Services for Early help and following this missed appointment the case was escalated to Child in Need. Conclusion Not being brought to appointments has implications for health but can also be an indicator of wider harm. Our study identified that initiatives to reduce missed appointments may be best focused on particular subspecialty clinics and target older patients. We have already begun an education programme to ensure staff attempt to contact families on the day when not brought, aim to offer another appointment and to view missed appointments through a safeguarding lens, particularly if this happens repeatedly. We are planning to repeat the data collection in 1 and 6 months to evaluate whether there has been a sustained change in practice.