BACKGROUND: Prior to the COVID-19 pandemic, there was an average no-show rate of 11% for the top four procedures (Biofeedback, Urodynamics (UDS), Video Urodynamics (VUDS), and Uroflow) performed in the main Nationwide Children's Hospital (NCH) Pediatric Urology clinic. No-shows have a double impact: the patient does not benefit from diagnostic testing/therapeutic treatments that may have notable clinical implications and the clinic loses revenue, resources, and clinic time that could have been dedicated to another patient. Our aim was to reduce the no-show rate for clinic procedures for select procedures from 11% to <8% by December 2022 and to sustain this reduction for one year.
METHODS: As part of a quality improvement initiative, monthly scheduled clinic visits and no-show rate data were collected for the top four procedures performed in the NCH Pediatric Urology clinic. To decrease the number of no-shows, we implemented two different forms of communicating appointment reminders to patients and families: reminder phone calls before the scheduled appointment and text reminders with specific instructions unique to their scheduled procedure. Control charts were used to track the no-show rates for all four procedures together and histograms were used to analyze annual no-show rates for the procedures individually.
RESULTS: From January 2019 to September 2022, 3098 patients scheduled one of the select procedures (952 Biofeedback, 868 UDS, 809 VUDS, and 469 Uroflow). The 2019 baseline no-show rate for all four procedures was 11% (114/1003) overall, 17% (55/323) for Biofeedback, 8% (24/312) for UDS, 11% (27/254) for VUDS, and 7% (8/114) for Uroflow. The number of scheduled visits and no-show rate were variably affected by the pandemic. After first confirming return to normal business operations post-pandemic by calculating scheduled appointments, we implemented both appointment reminder methods in December 2021. Following this intervention, collective no-show rate for all four procedures through September 2022 decreased to 8% (41/509) (Fig. 1). The no-show rates did vary over the 3-year study period for each procedure (Fig. 2). Three saw a decrease, however, one did not. Biofeedback no-show appointments decreased from 17% of scheduled visits to 11% (17/153), UDS no-show appointments decreased from 8% to 4% (6/155), and VUDS no-show appointments decreased from 11% to 9% (11/119). Uroflow no-show appointments instead demonstrated an increase from 7% to 9% (7/82).
CONCLUSIONS: A quality improvement initiative using multiple methods to remind patients of their appointments can potentially reduce no-show visit rates for pediatric urology clinic procedures with sustained success. Further interventions may be warranted to explore socioeconomic factors allowing for the addition of interventions that target social determinants of health with an eventual goal to minimize access barriers to healthcare appointments.
