A Process Analysis Approach to High "No-Show" Rate in Outpatient Palliative Care Clinic
Rodney Tucker, MD
Patty W Bunch, RN, BSN, OCN
Christine Ritchie, MD
Elizabeth Kvale, MD
University of Alabama at Birmingham Center for Palliative Care
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University of Alabama at Birmingham Center for Palliative Care Description
We present the use of clinic no-show data to inform a process analysis and subsequent PDSA (plan-do-study-act) cycles.
Goal
To decrease clinic "no-shows" by 30% for new referrals and 20% for return appointments to the Palliative Care Clinic.
Measures
appointment adherence, phone contact records, follow-up communication
Data Collected
Data on appointment adherence and records from the automatic appointment reminder system utilized by our health system were surveyed. Proportion of patients adherent with scheduled clinic appointments were stratified by visit type (new, return) and provider. Responses to telephone prompting service and information from follow-up contacts were collected. A process analysis was developed, and points were identified to undertake PDSA cycles to reduce no show rates.
Graphs/Tables
Table 1: No-show data by provider and visit typeTable 2: Results from phone appointment prompting service
Figure 1: Process Analysis
Table 3: No-show data by provider and visit type following first PDSA cycle
Summary of Results
Collection of data on clinic appointment adherence informed the development of a process analysis. This process analysis allowed us to strategically target PDSA cycles to achieve a reduction in "no show" rates. Subsequent PDSA cycles have been undertaken to work toward our overall goals of 30% reduction in no-show rates for new patients and 20% reduction for return visits.
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