Stop Blaming the Weatherman! Impact of Weather on Endoscopy No-Show Rates at a Midwest Safety Net Hospital

Abstract

Introduction: Weather extremes have long been known to affect human health and behavior. The noshow rate (NSR) for outpatient gastrointestinal procedures ranges from 4-41% based on the population and procedure performed. These procedures are frequently requested at safety-net hospitals, so it is important to identify potential barriers to care so that resources are efficiently dispersed. Weather conditions are often blamed for high NSRs and we hypothesized that poor weather conditions were associated with higher NSR at our outpatient endoscopy center. Methods: A 12-month, retrospective cohort study of the NSR for outpatient endoscopic procedures at a safety-net hospital in Cleveland, Ohio, was performed using local weather data from 1/1/2017 - 12/31/2017. Univariate analysis of weather conditions were evaluated. Categorical data was presented as frequencies/percentages. Mean and standard errors were calculated for continuous variables and assessed by analysis of variance (ANOVA)/t-test. Chi-squared test was used to analyze weather impact on high NSR between EGD and colonoscopy. A p < 0.05 was considered significant. Results: 7,935 patients had an average overall NSR of 11.8%. Average NSR for EGDs were 9.9%, colonoscopies 12.3% and advanced cases 11.1%. The NSR was highest in the spring (13.5%, p=0.04), specifically in April (15.3%, p=0.01) and lowest in September (9.0%, p=0.04). There is a greater likelihood of a high no-show for colonoscopies vs EGD when mean temperatures were at or below freezing (p=0.02) or with snowfall (p=0.03). NSR also were high for EGD's on federal holidays (25%, p=0.03) and colonoscopies on days following federal holidays (25.3%, p<0.01). Days of the week, wind speed, presence of precipitation, wind chill, temperature change from prior day and temperature (high, low and mean) all showed no significant differences in NSR.1113_A Figure 1 No Caption available.Conclusion: We present an early study evaluating the impact of weather on NSR for endoscopy procedures. Weather parameters had no correlation to the overall no-show rate for different endoscopic procedures. Subset analysis from our study is congruent with prior evidence that there is a high variation in no-show rates based on the month of the year. High NSR cause revenue loss, reduced satisfaction and poor disease control. Further research should try to determine if demographic variables affect NSR for endoscopic procedures in an attempt to optimize scheduling and available resources in a safety net hospital.1113_B Figure 2 No Caption available.