P1206 - Improved Communication Decreases No-Show Rates in Private GI Clinic

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Presenting Author(s)

Nicole Vaynberg, MBA (she/her/hers)

Texas Tech University Health Sciences Center School of Medicine
AMARILLO, TX

Nicole Vaynberg, MBA¹, Mary K. Jurek, BA², Alan Pang, MD³, Chanaka N. Kahathuduwa, MD, PhD³, Sameer Islam, MD, MBA³
¹Texas Tech University Health Sciences Center School of Medicine, Amarillo, TX; ²Texas Tech Health Science Center School of Medicine, Lubbock, TX; ³Texas Tech University Health Sciences Center, Lubbock, TX

Introduction: High no-show rates in outpatient clinics can have negative impacts on longitudinal patient care, clinic efficiency, and may increase reliance on emergency department visits. In our study, we aimed to address the issue of communication-related no-shows among nurse-practitioner (NP) providers in a gastrointestinal (GI) outpatient clinic. By implementing interventions to target communication issues, we sought to reduce the no-show rate for these NPs by 10% over a period of three months.

Methods: To understand the reasons behind appointment cancellations and no-show instances, data collection involved on-site personnel manually recording patients' reasons in a free-text format. Subsequently, the collected data was analyzed to identify common patterns and categorize frequently cited reasons. Interventions were then implemented to enhance patient engagement and communication. Statistical analyses were conducted using R statistical software, comparing the proportions of pre-cancellations, no-shows, and total cancellations during the pre-and post-intervention periods.

Results: Following the intervention, there were significant improvements in the proportions of pre-cancellations, no-shows, and total cancellations (p = 0.010, p = 0.039, and p < 0.001, respectively). Sensitivity analyses comparing pre- and post-intervention periods further confirmed the significant reduction in pre-cancellations and total cancellations (p < 0.001). When examining specific causes, cancellations due to internal scheduling errors significantly decreased (13.10% vs. 4.25%, p < 0.001). The proportion of patients who could not be contacted also significantly decreased (44.44% vs. 30.79%, p < 0.001). However, the proportion of patients not providing a reason for cancellation significantly increased from 10.91% to 25.48% (p < 0.001).

Discussion: The intervention period resulted in a significant reduction in no-show rates (p = 0.01) while simultaneously increasing the proportion of patients who did not provide a reason for their absence (p < 0.001). This rise in unexplained absences can likely be attributed to an overall decrease in no-show rates due to modifiable factors such as internal scheduling errors and the inability to contact patients. Implementing a standardized data collection system proved to be an effective strategy for addressing attendance issues in this clinic and could be easily implemented in similar settings.

	Pre-intervention	Post-intervention
	n (%)	n (%)	χ2 (df=1)	p-value	Adjusted p-value
Appointment no longer necessary	16 (3.17)	8 (1.7)	1.64	0.201	1
Appointment prep not done	19 (3.77)	24 (5.1)	0.72	0.395	1
Cost	14 (2.78)	10 (2.12)	0.2	0.651	1
Deceased	2 (0.4)	4 (0.85)	0.24	0.622	1
Did not give reason	55 (10.91)	120 (25.48)	34.09	< 0.001	< 0.001
Did not want appointment	16 (3.17)	18 (3.82)	0.14	0.707	1
Emergency	13 (2.58)	14 (2.97)	0.03	0.858	1
Forgot appointment	3 (0.6)	7 (1.49)	1.13	0.288	1
Internal scheduling issues	66 (13.1)	20 (4.25)	22.62	< 0.001	< 0.001
Out-of-town	5 (0.99)	0 (0)	2.95	0.086	1
Schedule conflict	30 (5.95)	42 (8.92)	2.71	0.1	1
Seeing another GI provider	4 (0.79)	5 (1.06)	0.01	0.919	1
Sick	19 (3.77)	33 (7.01)	4.43	0.035	0.706
Transportation	15 (2.98)	14 (2.97)	0	1	1
Unable to contact patient	224 (44.44)	145 (30.79)	18.73	< 0.001	< 0.001
other	1 (0.2)	7 (1.49)	3.51	0.061	1
Not scheduled with preferred provider	1 (0.2)	0 (0)	0	1	1
Childcare issues	1 (0.2)	0 (0)	0	1	1

Table: Table 1: Summary and comparison of specific reasons for pre- vs. post-intervention visit cancellations.
Each of the pre-and post-intervention periods was compared using a Chi-square test with a Yate’s continuity correction. The p-values were adjusted using a Holm-Bonferroni correction to maintain the family-wise error rate at 0.05.

Disclosures:

Nicole Vaynberg indicated no relevant financial relationships.

Mary Jurek indicated no relevant financial relationships.

Alan Pang indicated no relevant financial relationships.

Chanaka Kahathuduwa indicated no relevant financial relationships.

Sameer Islam indicated no relevant financial relationships.

Nicole Vaynberg, MBA¹, Mary K. Jurek, BA², Alan Pang, MD³, Chanaka N. Kahathuduwa, MD, PhD³, Sameer Islam, MD, MBA³. P1206 - Improved Communication Decreases No-Show Rates in Private GI Clinic, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.