Decreasing No-Show Rates to Pediatric Neurosurgery Outpatient Clinic - Back to Basics

Transcription

1 Decreasing No-Show Rates to Pediatric Neurosurgery Outpatient Clinic - Back to Basics Alan P. Yaacoub, Linda Beatson, Velda Green, Daniel Fulkerson, Jodi Smith, Laurie Ackerman, Andrew Jea, Jeffrey S. Raskin Goodman Campbell Brain and Spine - Indiana University - Department of Neurological Surgery

2 Disclosures None

3 Goodman Campbell Brain and Spine Indiana University Riley Hospital for Children Pediatric Neurosurgery Team My Patients Acknowledgements

4 Syllabus Background Methods Results Conclusions

5 Background Missed clinical appointments, or clinical noshows, are an important and potentially avoidable contributor to increased cost and decreased efficiency in pediatric neurosurgery Clinical no-shows often result in delayed diagnoses and treatments which contribute to negative effects on patient care outcomes. The national no-show rate varies by specialty and has been estimated to be between 5% and 10% among academic pediatric subspecialty outpatient clinics

6 Background Clinical noshows reduce the access of care for other patients and disrupt patient flow through the healthcare system Pediatric neurosurgery is a small subspecialty with high demand Riley Hospital for Children serves as one of only two pediatric neurosurgery providers in the state of Indiana Various methods have been implemented in order to help reduce no-show rates text message reminders automated phone call services live-person appointment reminder calls

7 Previous Studies Fiorillo et al., Study of no-show rates to academic otolaryngology clinic reported an overall no show rate of 20% among 22,759 visits Tan et al., Manual and automated text message reminders reduced follow-up no-show patients by 44% at the UK National Health Service Musculoskeletal Service Guzek, Clinical Noshow rates to a pediatric neurology clinic at IU have estimated a 26% no show rate with a monthly revenue loss of $15,000 to $27,000 No previous studies have investigated clinical noshows or utilization of appointment reminder services to pediatric neurosurgery outpatient clinics

8 Purpose Compare effectiveness of automated phone call services and live-person appointment call reminders

9 Methods The Riley Hospital for Children Department of Neurosurgery implemented automated phone call services from the months of March to July 2017 Live-person appointment reminder calls performed by a work-study student from August to December 2017 A retrospective cohort study was performed for all patients who missed appointments during the study period

10 Results A total of 465 no shows among 5224 appointments were reported during the study period The overall no-show rate between automated calling services and in-person calling was 10.3% and 7.9%, respectively The average monthly rate of noshows showed a significant reduction when live-person calling was utilized (7.9% ±0.2%) compared to automated calling (9.9% ±0.3%), p<0.005

11 Clinical Appointments and No-Shows March April May June July Aug Sept Oct Dec No shows Total appts

12 Percent No Shows Clinical No-Show Rate March April May June July Aug Sept Oct Dec

13 Analysis A total of 465 no-shows among 5224 appointments were reported during the study period The average monthly noshow rate was significantly reduced when live-person calling was utilized (7.9% ±0.2%) compared to automated calling (10.3% ±0.3%), p< t-test: Two-Sample Assuming Unequal Variances 2500 Automated Student No shows Total appointments Mean P(T<=t) onetail No shows Automated Personal Total appts

14 Conclusions Although automated phone systems for appointment reminders are becoming more common, the benefit of live-person appointment reminder calls should not be understated. Enacting in-person calling services over automated calling has shown to be an effective strategy to reduce clinical noshows for the authors institution. Additionally, the improvement in no-show rates was seen partially during winter months when illness, holiday disruptions, and inclement weather generally contribute to higher no-show rates. With technology and automation always advancing around us, it is important to remember that the human connection is an important aspect in interactions with patients.

15 Future Considerations Analysis of patient-specific factors in targeting appointment reminder services Cost burden and cost reduction analysis Consider multimodal approaches (text messaging services with in person calling)

16 Jeffrey S. Raskin MS MD Pediatric Neurosurgeon Goodman Campbell Brain and Spine Assistant Professor Thank You Indiana University Department of Neurological Surgery