Plastic and Reconstructive Surgery Resident Indigent Care Clinic Optimization by Improving "No-Show" Rates

Area of Science:

• Health Services Research
• Quality Improvement Science
• Patient Access to Care

Background:

• Patient absenteeism presents a significant challenge to healthcare efficiency and access, particularly for indigent populations.
• Routine no-shows strain healthcare resources and impede timely care delivery.
• Understanding and reducing patient absenteeism is crucial for optimizing clinic operations.

Purpose of the Study:

• To quantify, understand, and attempt to reduce patient absenteeism in a plastic and reconstructive surgery resident indigent care clinic.
• To identify factors contributing to missed appointments.
• To address limitations in data collection related to patient rescheduling.

Main Methods:

• Retrospective review of one year of patient data to establish a baseline no-show rate.
• Implementation of three consecutive 2-month Plan-Do-Study-Act (PDSA) cycles to address absenteeism.
• Data collection and analysis focusing on daily and monthly no-show percentages.
• Investigation of electronic medical record (EMR) system flaws impacting appointment tracking.

Main Results:

• The baseline no-show rate was 25%.
• Despite quality improvement efforts, the average no-show rate increased to 31% over the study period.
• A critical EMR flaw was identified, where rescheduled or canceled appointments were not accurately tracked, skewing initial data.
• The study highlighted a subset of patients who were unreachable or did not follow up with appointments.

Conclusions:

• Initial data on patient absenteeism were significantly skewed by an EMR tracking limitation.
• Quality improvement initiatives did not reduce, and appeared to increase, the no-show rate due to unaddressed systemic issues.
• Effective strategies to reduce absenteeism require accurate data capture and addressing barriers to patient follow-up and contact.