Case Study: Reducing Patient Appointment No Show

Capital Health is Nova Scotia’s largest provider of health services. They operate hospitals, health centers, and community-based programs throughout Halifax Regional Municipality and the western part of Hants County. Capital Health is 12,000 employees, physicians, learners, and volunteers providing medical and surgical care, mental healthcare, community health programs, addiction prevention and treatment, and environmental health services.

As an academic district, Capital Health helps educate tomorrow’s healthcare providers and administrators and engages in research into new treatments, cures, processes, and practices. Capital Health serves the 500,000 residents of the district and provides specialist services to the rest of Nova Scotia and Atlantic Canada.

Each day, thousands of Capital Health patients have scheduled appointments. Until recently, patients received reminders about upcoming appointments only occasionally. According to Betty Bouchie, the senior systems analyst for Capital Health Voice Services, “The staff was doing some calls, but it was very sporadic. When they had a break from people coming and going, they would take a list and try and call people.”

Reducing No Shows: When a patient doesn’t show up for a scheduled appointment, a number of things happen. There is a loss of productivity for the nurses, doctors, and technologists scheduled to work with that patient, a loss of utilization for the equipment allocated for that patient, and the patient has to be rescheduled, or in some cases, put on a wait list.

For these reasons, the Nova Scotia Breast Screening Program approached the Capital Health Voice Services call center because they realized the value of reminding patients about their upcoming appointments. “They had identified that making calls made a big difference,” said Bouchie. “So they approached us to say, ‘We need help. We need this done. We cannot do it ourselves, and we thought people who worked on the telephones would be the best people to do it.’”  The call center agreed to make reminder calls for them as a manual process, in order to see how much of a difference it would make. The appointment reminder calls made such a substantial impact that Capital Health soon saw the need for an automated system. They selected the 1Call Pro Show Automated Appointment Reminder Solution.

The Initial Results: “Once we got up and running, we actually dropped their no-show rate from nine percent to one percent. When we started doing calls for them, their average wait list was about nine months. We dropped it down to about six months with manual calls, and it’s three months now,” stated Bouchie.

Natalie Klaus, Capital Health’s manager of communication services, voice services, commented, “We currently process approximately 11,000 automated calls per month, which is maybe one percent of the total number of appointment reminder calls for Capital Health.”  This number includes reminder calls only for the Nova Scotia Breast Screening Program and for some of the diagnostic imaging program.

“The second that the word got out of the impact we had made, we had people lined up down the block,” added Bouchie. “They want the same thing.”

Hospital-Wide Benefits: The primary benefits that Capital Health has noticed are the significant reduction in the no-show rates and the reduced wait list time. Another benefit of the automation is freeing up staff. According to Klaus, “It’s mainly the no-show rate, and it’s also about redeploying current resources to do other tasks. So if you had a person assigned to make calls all day, now you can have them complete other tasks.”

An unexpected benefit of appointment reminder calls is related to the wait list. Because patients get the reminders in advance, if they do need to cancel, they can call to reschedule, and then a person from the wait list can be placed in that appointment. Since the appointment time can be scheduled with a wait list patient, it is not lost on a no-show who would then also need to be added to the wait list.

Perfecting the Process: Bouchie and Klaus have learned several key things about appointment reminders. They have found that calling three days before the appointment is optimal. Four to five days is too long, and the patients forget about it. However, any less than three days is too late, and they may not reach the patient. They also found that using a unique caller ID number for each department or group makes it more likely that people will answer the call. “Since we display a number, people are very likely to pick up,” said Bouchie.

Each patient appointment is set up to try as many as six times to leave a reminder message twice each day, morning and evening, for three days before the appointment. They’ve found that they typically reach the patient on the first call.

The messages that patients hear are customized, depending on the specific needs of the department or group. They have included important reminders, such as a facility being scent-free, and also reminders that the patient should arrive fifteen minutes before their appointment time.

Each group has a unique callback number if patients need to reach them.  The system does a look-up to determine if the number called is local for the patient; if it is, then a local callback number is provided. If the number called is long distance, then a long-distance callback number is given.

Another helpful feature is automated data importing. The process of receiving different types of data from the various groups is automated and is scheduled every night. Data is imported five days in advance so if a problem does occur receiving the data, several people are alerted via email. When this happens, the cause can be investigated and fixed before there is any impact to the reminder calls.

Adding More Services: Capital Health started handling appointment reminders for two of the most complex groups. They continue working to offer these services to more departments and groups. Currently, patients only receive phone calls for appointment reminders. This is primarily due to patient privacy. Capital Health is discussing adding email reminders, but they will need permission from patients to do this. “We want to make sure we have our processes in place and everything thought through before we start rolling it out with email as well,” stated Klaus.

More recently, reminder calls for the Department of Medicine have been added. “They love it. We did a pilot of four groups, and it went great,” Bouchie said. “They want to add the rest as soon as possible.”  This “is a great product.”  Bouchie added. “It has made an impact just in its beginnings, and it will make a huge impact as we go forward.”

[From the April/May 2011 issue of AnswerStat magazine]