Background: Patients missing scheduled appointments, or no-shows, is a pervasive issue across outpatient clinics. The estimated no-show rate among primary care clinics ranges between 14% and 50%. No-shows are estimated to cost the US healthcare system $150 billion a year. At many clinics no-shows have necessitated overbooking clinic slots to maintain efficiency. Ultimately, patient no-shows and the overbooking they necessitate causes problems for both the patient and provider.

Methods: We used the PDSA (plan/do/study/act) cycle from quality improvement methodology. We determined the baseline no-show rate at the Parkland Diabetes Clinic, an endocrinology clinic with 16 providers (including specialists and advance practice providers) which sees ∼1200 visits a month. The baseline no-show rate from June 2018 to May 20was ∼31.9% ± 2.19. We then examined clinic processes to determine reasons for no-shows through process mapping and root cause analysis. Mapping of the scheduling process identified process inefficiencies. Phone call surveys were conducted with patients with high no-show rates. Using the process map and survey data, we brainstormed interventions to target root causes of no-shows. Our first intervention was ensuring that every patient received a phone call reminder for their appointment. Our second intervention was limiting the degree to which a third-party call center handled scheduling for the Diabetes clinic.

Results: Interventions were implemented in August 2020, and subsequent data collected from November 2020 to October 2021 was analyzed to see changes in the no-show rate. The average no-show rate during this post-intervention period was ∼22.2% ± 2.50 (t-test, p <0.05) , a significant decrease from the baseline rate of ∼31.9% ± 2.19. We predict this reduction will result in more consistent follow-up care, less risk of disease progression, and increased clinical efficiency. Our next step will be to transition our interventions into long-term sustainable solutions to maintain the lower no-show rate.


F.Jafri: None. U.Gunasekaran: None.

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