Improving caregiver attendance at forensic service users’ psychiatric clinic appointments

In Singapore, families play an important role caring for mentally disordered offenders. They are particularly important in cases where courts oblige psychiatric assessment, because they provide corroborating information not otherwise volunteered. However, their attendance is generally low. Our quality improvement project sought to increase caregiver attendance at outpatient visits. We followed WHO guidelines for quality improvement, determined the root cause of poor attendance, and devised three Plan–Do–Study–Act cycles over six weeks in late 2013. We followed their impact for 12 months. Case managers and medical social workers implemented three strategies to address issues of poor communication and awareness, which led to poor attendance. Prior to our project, caregivers attended 47% of outpatient visits. Following the implementation of our strategies, rates rose to 70%, sustained over the 12 following months. The entire case management department adopted our strategies. Simple changes to standard operating procedures improved the rate of caregiver attendance at follow-up appointments.