Abstract 247: Process Improvement Initiatives to Reduce No Show Rates in Rural Communities

Abstract

Objective: A large pediatric academic medical center (AMC) acquired an out-of-state private cardiology practice serving rural communities and without an EMR. No show rates at the private practice consistently ranged from 20-40%, compared to 11% at the AMC. No shows contribute to inefficient use of clinician time and access to care challenges for other patients. Upon acquisition, process improvement efforts began with the goal of decreasing the abnormally high no show rates. Methods/Findings: Under private practice, staff scheduled patient appointments without inquiring for their availability and then notified patients of their appointment date and time via letter 10 days prior to the scheduled appointment and then by phone 2 days prior to the appointment. Immediately following the acquisition in December 2018, staff began calling patients to inquire when they would like to be scheduled based on their availability. Patients were scheduled six months out, so the true impact of this process change would be fully realized in May 2019. Once an EMR was implemented, a dashboard was created to monitor no show rate data and identify trends. After six months, no show rates only slightly improved, so in addition to the automated emails, calls, or text reminders from the scheduling center, a dedicated staff member began making reminder calls to patients the day before their appointment. As a result of the process improvement efforts, no show rates decreased from a high of 42% to 16% in eight months. Further, to better understand why patients were not showing for their appointments, staff began calling patients after a no-show appointment to determine if there were barriers for not showing and offering to reschedule the appointment. Data collected shows that out of 470 no show appointments from May 2019 to December 2019, 117 patients had disconnected phone numbers, 230 had appointment reminder messages left on their voicemail, 68 did not answer the call and did not have voicemail to leave a message and 55 patients confirmed their appointment with staff, but did not show for the appointment. Of the 470 no shows, 394 were pediatric patients and 76 were adults. Data shows 185 out of 470, or 39% of reminders never reached the patient, and an additional 49% went to voicemail and may not have been heard. Conclusion: No show appointments negatively impact clinic efficiencies and the ability to provide care to the greatest number of patients. When a patient doesn’t show for their appointment, they are non-compliant with their recommended care and reserve a clinic appointment that another patient may need. Small tests of change were made in phases to ensure appointments were convenient for patients and families and metrics were set and tracked to monitor improvement. By implementing new patient-centric processes and data tracking, more patients in rural communities receive the required follow up CHD care, leading to improved outcomes.