Reducing no show rate in a community-based clinic

Issue: No shows are common issues in medical practices, especially those that target underserved population. Typically, disproportionate number of no shows is caused by a group of clients who chronically miss their appointments. Frequent no shows not only impact clinic productivity but also clients' continuity of care and health outcomes. Furthermore, it leads to limited access to care as it prevents other individuals who need care to schedule medical appointments. A common strategy used to address no show issues is double booking, however, this often result in disrupted clinic flow if both clients show up. Description: At Harlem United (HU), a community-based organization in Harlem, New York, high no show rates in its Primary Care (PC) clinic is attributed to a group of clients categorized as “chronic no show”. These clients frequently miss their scheduled appointments without cancelling or rescheduling in advance, making PC no show rate disproportionately high. In 2012, a strategy using electronic health record (EHR) was implemented, focusing on putting chronic no show clients in same day appointment slots rather than scheduling medical appointments. A list of chronic no show clients is generated from EHR, for whom an “action item” is created in EHR and sent to Patient Navigator (PN) team with descriptions of “actions” needed. Upon receiving the “action items”, PNs conduct indicated “actions”, such as searching clients identified, scheduling them in same day appointment slots, and escort them to the clinic within specified window period. Lessons learned: Using Plan-Do-Study-Act (PDSA) method, no show rate decreased from 52% to 38% after implementing the “action item” strategy for one month, demonstrating the efficacy of the strategy. Recommendations: To assess whether or not observed changes are improvements, it is necessary to adopt a Continuous Quality Improvement model that systematically evaluates quality of services and efficacy of new strategies