Keeping Appointment No-Show and Admission Rates Low

Background of the problem: Active clinic patients’ non-adherence to follow-up appointments have higher ED and hospital admission rates. Reminder phone calls can improve appointment adherence, but sustaining the process can be challenging.

Literature review: Annually, the missed appointment rate for outpatient clinics is approximately 15 % to 30%. Research supports patient non-adherence to follow-up visits have a higher encounter rate for both ED and hospital admissions. Reminder phone calls are effective at reducing missed appointments. Optimizing the effectiveness of appointment reminders, includes accurate patient contact information.

Objectives/purpose: The goal is to decrease 30-day ED and hospital admission rates for active chronic care clinic patients by improving appointment adherence.

Methods: Initiating reminder phone calls 24-hours prior to appointments with a standardized script was first implemented November 2016. The project was successful in decreasing no-show rates. Further analysis also showed a decrease in ED and hospital admissions for active chronic care clinic patients.

Beginning December 2017, the chronic care clinic revisited the “reminder phone call process.” Staff determined contact information for patients was not always accurate and compliance to the standardized script was underutilized. Review of the phone call process and updating the contact information at every visit was addressed during daily huddles and monthly staff meetings.

Outcomes: The reminder phone call process has shown to improve appointment adherence, resulting in fewer ED and hospital admissions within 30-days of the scheduled appointment. The quarterly data shows a combined admission rate of 16.7 % before implementation of phase 1, and then it drops between 13-14% after phase 1. Phase 2 shows this process helps with sustaining the admission rates to around 14%.

Conclusion/implication for nursing practice: The chronic care clinics reminder phone call process has been shown to reduce unnecessary hospital admissions and ED encounter visits. The collaborative effort of using reminder phone calls for patients can improve no-show rates and also reduce the number of patients who are lost to follow-up. This initiative has achieved favorable outcomes which have sustained over time. The clinic will continue to assess the success of the process annually and determine the need for updates to their current process.