Patterns of appointment cancellations and no-shows across and within ophthalmology subspecialties

Preventing appointment non-adherence is critical for efficient ophthalmology clinic operations and protecting patients' vision. This study examined patterns of cancellations and no-shows across and within comprehensive and subspecialty clinics.

This cross-sectional study used multivariable logistic regression to analyse appointment records from Kensington Vision & Research Centre, Toronto, Canada, between 2013 and 2024, covering comprehensive ophthalmology and 10 subspecialties.

In total, 760,678 appointments involving 109,435 patients were included. Overall, 26.5% were cancelled and 4.7% were no-shows. Male sex is associated with 25% higher no-show likelihood but 9% lower cancellation likelihood. Patients ≤50 years old, particularly those aged 20-30, are significantly more likely to no-show. Greater home-to-clinic distance is linked to fewer no-shows but slightly more cancellations. After 4 PM, cancellations increase while no-shows decrease, and 12-1 PM carries the lowest risk for both. Mondays and Saturdays had the highest no-show and lowest cancellation rates, respectively. Having only one scheduled visit is the strongest predictor of no-show (OR 3.73, p_adj < 0.001). Subspecialty analyses revealed heterogeneity, with some countering overall trends.

This large-scale study identified demographic, temporal, and clinical factors driving appointment non-adherence. Findings support actionable, subspecialty-specific strategies, including targeted reminders and navigation for first-time or young patients; increased 12-1 PM scheduling; intensive reminders for infrequent uveitis, comprehensive, and cataract visits; and allocation of late-afternoon slots for patients at high no-show risk and Saturdays for patients at high cancellation risk, noting higher no-show risk for uveitis and neuro-ophthalmology. These measures aim to improve adherence, efficiency, and patient-centred care.