Medical appointment no shows are an annoying but very real part of life when working in health care.

Tackle your medical appointment no shows with Savience. Our solution can be implemented with aspects to help reduce no shows, helping you to make the most out of the time you have.

­­­Background to Medical Appointment No Shows

As resource pressures grow, health workers and officials in Canada and the United Kingdom are raising awareness about the costs of patients not showing up for appointments.

Last year, the UK’s National Health Service revealed that a 5% no-show rate cost the system £216 million pounds in a year, while a Nova Scotia family practice posted on Facebook that a single month of no-shows wasted 36 hours of physician time that could have been spent on other patients. But estimating the full impact of these missed appointments is complicated.

Tracking and reporting on the problem is not consistent in Canada and the data collected suggests that no-show rates vary widely. Recent studies of four rural and urban academic family practices in Quebec and an inner-city clinic in Saskatchewan, respectively, reported no-show rates of 10% and 25%. Older reports from Newfoundland and Labrador and Alberta cite no-show rates of 11% and 20-30%, respectively.

The average no-show rate is about 23% internationally. Hospital clinics serving poorer populations tend to report higher rates while some family practices may report much lower rates. For example, Dr Sohail Gandhi, president of the Ontario Medical Association, says the no-show rate at his Georgian Bay clinic is below 1%.

Many Canadian doctors argue that patients not showing up for appointments drives up wait times. Dr Andrew O’Keefe, an allergy specialist based in Newfoundland, says the 13% no-show rate at his clinic “increases our wait time by 13% longer than it needs to be.”

Dr Kathleen Ross, president of Doctors of BC, says that while her clinic’s rate is much lower, at around 3% to 6%, missed appointments still lead to delays. Often, discussions about no-shows focus on the overhead costs for doctors, she says. “But truly, for me, it’s about maintaining access.”

Costs can add up quickly, too. Although most doctors aren’t compensated for their time when patients don’t show up, according to a 2016 review, some primary care networks in Alberta paid specialists more than $200 per hour for no-show appointments.

Some clinics have found ways to reduce disruption from no-shows and late cancellations. At Sellar’s clinic, staff keep a list of patients who can fill missed appointment slots on short notice.

Ontario geriatrician Dr Amina Jabbar, who practices at Trillium Health Partners in Mississauga, says the clinic where she completed her residency had a similar list. She cautions, however, that this strategy privileges patients who have easy access to transportation. Studies show that patients who miss appointments tend to be poorer and face barriers, such as childcare obligations, transit barriers and mental health and addiction issues.

Often, patients have good reasons for missing appointments. The study of Quebec academic family practices found that most patients didn’t show up for appointments because they felt better (22.9%), while others cited work and family obligations (19.9% and 14.5%), conflicting medical appointments elsewhere (15.7%), transportation issues (15.1%) and feeling too sick (13.9%). More than half admitted they forgot to call to cancel, but one in 10 didn’t know it was necessary and a similar proportion said it was impossible to reach anyone at the clinic.

From CMAJ News 21 Jan 2020

Strategies to Reduce Medical Appointment No Show Rates

What strategies can we use to reduce medical appointment no shows?

It is widely believed that patients that are more engaged in their healthcare are more likely to experience better healthcare outcomes and naturally, attending outpatient appointments is central to this.

Deploying appointment reminders and/or the Convey appointment manager app are both great ways to start tackling the chronic No Show situation whilst providing evidence-based monitoring and performance capabilities.

Appointment Reminders

The use of SMS, email and voice reminders is a well-proven approach that gently reminds patients of their upcoming outpatient appointments and can help reduce medical appointment no shows. reminders are often based on patients’ own preferred choice of communication method.

Savience has been delivering appointment reminders such as this for our UK, Irish and Canadian customers for many years now, sending out many thousands of reminders each day.

As with most technologies the possibilities grow and evolve over time. Here we look at a few of the current adoption strategies being enjoyed across our deployed customer base.

Regular Reminders

Healthcare providers using our reminders service have the possibility of setting up and managing their own appointment reminders using any combination of email, voice, and SMS. All of which is completely under the control of the local system administrator.

Reminders are typically configured at the clinic or specialty level. This ensures that the information being sent is particular to that clinical area and the type, timing and content of the reminder is customised to meet those patients’ needs.

It’s always interesting to see how providers use the options available to them in different ways. For example, for a particular clinic type it may be that a SMS and email reminder is sent immediately upon the appointment being booked. This is then followed with a voice reminder sent 1 week prior and another text reminder the day before the appointment date.

Which type of reminder to use, its timing and the wording of the content is more of an art than a science and does vary depending on different patient cohorts and location.

Post appointment, there’s also the option to send a follow up “reminder”, which is commonly being used for satisfaction surveys and the like. Another flexible way to help gather feedback and information that can be used to review and improve services to help improve No Show rates.

Interactive Reminders

As well as alerting patients to a forthcoming appointment, the hospital may wish to use a text or voice reminder to elicit a response from a patient that can then be used by the hospital. These are known as interactive reminders and work slightly differently depending on whether voice or SMS channels are utilised.

For example, you may wish to remind a patient that their appointment is due in a couple of days’ time, but also request that they take an action. It could be something along the lines of “say or press 1 to confirm, say or press 2 to reschedule” etc.

This is a key feature as patients that provide some or any form of feedback prior to their appointment are far less likely to be a No Show on the day. Interactive reminders are rapidly becoming the norm, especially as it is clear that patients welcome this type of communication.

A secondary benefit from the use of interactive reminders is that clerical teams with responsibility for following up on patient appointments and proactively tackling No Shows are now able to better focus their efforts on those patients that haven’t responded or confirmed.

Clerical teams, using Savience Clarity, can access a specialised view of response types, so the follow-up process is managed in an organized and structured manner.

Bespoke Targeted Reminders

A more recent development of the reminder service has been to identify specific subsets of patients and deliver tailored information and targeted messaging that is pertinent and relevant to them.

Early signs suggest this is a very effective approach for certain groups of patients e.g., send a SMS reminder to all patients that have yet to register with the Convey app and/or those who have registered but for whatever reason have disabled their Convey app notifications.

In this example, not only are patients being reminded about the self-management features available in the app, but the hospital can also save money by only sending SMS reminders to those who can’t be messaged by other means i.e., Convey and its in-app, onscreen notifications.

The Convey App

By promoting the Convey app, hospitals, and other healthcare providers are empowering their patients and service users with a mobile app that, by its very nature and patient-led design encourages patient engagement and greater ownership of their healthcare.

As we said earlier, the more involved a patient is in the management of their healthcare the less likely they will be to not attend their outpatient appointments, but with Convey the benefits and possibilities are even greater than just addressing No Show rates.

Managing Appointments

The core function of the Convey app is to allow patients to view and manage their upcoming appointments. Once registered and logged in, patients can view details of their appointments whenever they wish, simply by opening the app on their mobile phone.

Against each appointment, patients can be provided with the options to request an appointment is cancelled or rescheduled. With this being a very quick and easy activity to perform the hope is that patients will seek to rearrange an appointment via the app rather than simply not turn up on the day.

Another key feature of the app is in giving patients the ability to confirm their appointment. This confirmation window is determined by the hospital and current thinking is that by allowing patients to confirm earlier than has been the case in recent COVID times, they in turn will be less likely to be a No Show.

This has been made possible by including any ILI type screening questions to be asked when the patient checks in (again using just the app) rather than just at time of confirming an appointment.

Managing Demographics

Through the Convey app, hospitals can allow patients to view and even update their demographic details. These updates are integrated back into the main booking system, thus helping to improve patient related data that can help patients receive traditional correspondence in a timely fashion.

Notifications

With a release date of early January 2023, Savience is delighted to be unveiling a new suite of notification options that will significantly improve the Convey patient experience.

In brief, each time there is a new, amended, or cancelled appointment, the Convey app will provide an on-screen notification alerting the patient to the specific update. The expectation is, for those patients registered with Convey, the new notifications, in conjunction with the new Clinic Info button (see below), we will see an increase in engagement as they seek to manage their appointments from the convenience of their mobile device.

Clinic Information

Convey now enables clinic information to be displayed. Accessed via an icon next to each patient appointment, the Clinic Information screen will show any pre attendance preparation that the patient is required to undertake. These instructions are produced by the local clinical or system administration team and added to the Convey configurator.

Think of this as replacing the hard copy advice leaflets sometimes sent to patients. If patients have the right information to hand in a timely fashion, they can arrive for their appointment confident in the knowledge they have been adequately informed and prepped for any specific procedures or test etc.