Managing No-show Rates in Tertiary Care Hospitals - Research Paper Example

Reducing and Managing No- show Rates in Tertiary Care Hospitals al Affiliation) Reducing and Managing No-show Rates in Tertiary Care Hospitals Abstract No show rates are a matter of concern to many governments, hospitals and medical institutions (Johnson, Mold & Pontius, 2007, p 541). Patients book appointments and fail to turn up for these appointments, leading to inconveniences to both themselves and the hospitals. No-show rates are defined as the rate at which patients fail to keep their appointments already pre-scheduled over a certain period. There is a need to investigate reasons for the high rates and methods of reducing these rates (Hasvold & Wooton, 2011, p 358). In that regard, the issue of patients failing to show up was investigated through a research conducted on more than 1000 of the patients at our hospital. The research was undertaken by the use of a telephone interview, and found the reasons for no-shows among patients in different hospitals namely specialized women and children’s’ hospitals and the main hospitals Purpose  The purpose of this research work is to come up with ways of reducing the rates at which patients fail to show up at hospitals for booked appointments with physicians. This paper shall look into the reasons why no-show rates are high. In addition to that, this paper shall investigate the methods of managing and reducing the no-show figures, so that the rate at which patients fail to show up for appointments can be kept low. This will be done with the aim of improving the quality of medical services provided and increasing the satisfaction of patients. Methods  The method preferred for the research work is the Six Sigma method. This method seeks to achieve an improvement in process output quality by pinpointing and getting rid of the factors that cause defects. In addition to that, the Six Sigma helps minimize viability in the processes of business. The no-show rate was calculated using the following formula: No. of patients with pre-scheduled appointments who failed to show up X 100 Total No. of patients with pre-scheduled appointments Result  The statistics collected over the month of December 2012 indicated that the average percentage of outpatients who did not show up for consultation in hospitals was at 31%. When segmented, the rate of no-shows stood at 19.58% in the women- specialized hospital, 35.71% for the rehabilitation hospital, 30.7 % for the children-specialized hospital and 37.15 for the outpatients at the main hospital. Conclusion  The rates of no-shows in hospitals are very high, especially in the main and rehabilitation hospitals. The effects of no-shows on a hospital will continue to be felt for as long as there are no measures put in place to curb the rate at which patients fail to present themselves at the hospitals for their pre-booked appointments (Johnson, Mold & Pontius, 2007, pg 534). In order for the tertiary care hospitals to reach the set goal of a 25% no-show rate by the end of the first quarter of 2014, measures and recommendations from research works such as this should be implemented by the hospital authorities and health care agencies. This will go a long way towards ensuring that fewer people miss appointments throughout the year (Liu, Ziya & Kulkarni, 2010, pg 352). Key words  No-show rates- Rates at which patients fail to show up for pre-scheduled appointments in hospitals Appointment- Scheduled consultative meeting between a patient and a physician Scheduling- Process of setting up a meeting between a patient and a physician Rescheduling- Changing the time for a scheduled meeting on a roster. Physician- Individual involved in medical practice RESEARCH PAPER Introduction Despite the government and medical agencies striving to put in place mechanisms that would enhance access to medical care by the public, the rate at which members of the public book appointments with medical practitioners and fail to present themselves for their appointments remains high (Liu, Ziya & Kulkarni, 2010, pg 352). On average, close to a third of all appointments booked at a hospital are no-show, meaning that the patient fails to turn up at the hospital to consult physicians on matters that prompted them to book the appointments in the first place. It is this concern that this paper seeks to address, while coming up with the most plausible solutions to help in reducing and managing the no-show rates in hospitals. Methods  Because of the amount of time we have been observing the patients and the experience we have with patients, we decided to collect primary data by the use of phone calls made to more than 1000 patients was used for this research. This method was preferred because the data would be easy to collect, with regard to time taken to collect the data and the quality of information to be gathered. In addition to that, this method of data collection was considered to be cost effective, since the researcher did not need to travel to the location of the patients to get the information needed. The costs involved were mostly telephone costs. The Six Sigma method was adopted to improve process output quality and to remove the causes of errors in the operations of the hospital. Results  The results indicated that 31.5% of the outpatients at the tertiary hospital failed to show up for their pre-booked appointments. When these figures are broken down, the women-specialized hospital had a no-show rate of 19.58%, the rehabilitation hospital had a no-show rate of 35.71% while the children-specialized hospital had a no-show rate of 30.7%. The main hospital had a no-show rate of 37.15. From these statistics, it is clear that the more patients at the main hospital than in each of the other hospitals failed to show up for their pre- booked appointment. The results also indicate a median of 31.5%, with a maximum of 40.5% and a minimum of 25.2%. the mean was 31.638 and the standard deviation was 4.667. Discussion  The high rate of patients failing to turn up for their pre- scheduled appointments has become a matter of concern for health authorities in the country. From the data collected, almost one in every three patients who booked an appointment did not honor them. At any one time, the highest rate of patients not showing up for pre-booked appointments is 40.5%, while the least rate is 25.2%. These figures can be affected by other variables, but the degree of change will be within the range of 4.667% from the figures as indicated above. The research work revealed certain reasons that explain the high rate of no- shows in hospitals. One such reason is the absence of proper information on patient contacts (Baron, 2011, pg 62). This has led to patients not being reminded on their pre- booked appointments. Hospitals should have such information intact and properly stored in order to send messages aimed at reminding patients of pre-booked appointments. A poor information system hinders this process, therefore making it easy for patients to forget to show up for these appointments (Eder, 2000, pg 36). Another reason is double booking. Double booking occurs where a patient visits a hospital and scheduled more than a single appointment for the same medical reasons and in the same specialty (Hall, 2012, pg 73). These patients double book these appointments oblivious of the effects that it has on time management of hospital employees. If these double bookings are not detected on time, there are high chances of time being wasted. The situation that double booking creates is further complicated by the fact that the information systems in most hospitals cannot effectively detect these anomalies in time (Eder, 2000, pg 47). Even in instances where such anomalies are detected, the hospital management finds it difficult to decide on the appointment that should be kept and the one that should be cancelled (Hall, 2012, pg 69). Another reason is an increasing number of patients opting for walk in appointments. Most patients prefer walking into a hospital randomly and consulting a doctor or a nurse for their medical needs (Baron, 2011, pg 88). In the event that such patients had already booked an appointment for the same medical concerns, they may not see the essence of honoring them after seeing a physician. Further, there are transportation problems faced by both the hospitals and the public. Patients may find it difficult to reach the hospital due to such problems. Instead of facing these transport hurdles to honor an appointment, they opt to stay at home. Many hospitals do not have adequate ambulances to ferry patients to the hospitals. The effects of not showing up for scheduled appointments affect both the hospital and the patient. One of the effects of no- shows, as found out from the research work, was the wastage of resources (Johnson, Mold & Pontius, 2007, pg 537). When an appointment is being booked, there are resources used such as paper used in paper work, files and even medication that has been set aside for the patient after a prescription is done by a doctor. In the event that the patient fails to show up at the hospital, these resources become wasted since they are not put to effective use as had been planned. Time as a resource is also wasted, considering that the hospital spends time waiting for these patients yet they fail to present themselves for their appointments. Failure to show up for an appointment at a hospital also contributes to additional time used to access health care (Parikh, et al, 2010, 547). This is because other patients who may need to be served by a medical practitioner may fail to get served on time, owing to the fact that the practitioner has to honor an appointment with another patient, who later ends up not showing up for the same. Further, the patients who fail to turn up for their appointment prolong the period during which they should get complete medical assistance to the point where they recover. Non- show patients also contribute to their lack of satisfaction. By not presenting themselves at the hospitals for their scheduled appointments, patients fail to get adequate medical care as they should, therefore they may interfere with their treatment process (Parikh, et al, 2010, p 548). Recommendations and Conclusion In order to reduce the rate of no-shows, some recommendations have to be implemented. To begin with, there is a need for hospitals to upgrade their information systems (Baron, 2011, p 132). The hospitals can employ up-to-date technology in information storage (Brown, Stone & Patrick, 2005, p 96). This will assist in early detection of instances such as double bookings. An improvement of a hospital’s information systems will also help hospitals to communicate effectively with their patients and remind them of scheduled appointments through phone calls and SMSs (Ball, Wiever & Kiel, 2004, pg 102). A message can be sent to the patient a day before the appointment as a reminder and another one at the time of the appointment asking them to confirm attendance (Hasvold & Wooton, 2011, pg 364). Further, there should be a review of all the files at hospitals to cancel double bookings. Hospitals should then communicate with the patients and settle on a single date for the appointment (West & Applegate, 2009, pg 67). This will save on time and other resources. The free slots can then be reallocated to shorten the time for access to medical care. Patients should also be educated on the effects of missing scheduled appointments. They should be advised to inform the hospital of any changes that they would like to make in a timely manner to help in organization of activities at the hospital (Brown, Stone & Patrick, 2005, pg 116). The hospital can have a toll- free telephone line for that purpose. Technologies such as a webpage on the internet allowing patients to reschedule appointments and a QR code for smartphones can be adopted to help in scheduling and rescheduling of appointments (Eder, 2000, pg 55). In addition to that, hospitals can train its staff on effective scheduling practices (West & Applegate, 2009, pg 75). This can help in the avoidance of cases of double bookings. Hospitals should also encourage patients to book appointments before visiting. Walk in appointments should be discouraged. The public can be sensitized on this through a campaign drive in the media (Ball, Wiever & Kiel, 2004, pg 124). In addition to that, it is imperative to cancel appointments booked by patients who were admitted before the scheduled appointment (Ramutkowski, 1999, pg 189). This will help in reducing the number of appointments and their rescheduling. Further, it should be determined whether the time used should be Gregorian or Arabic. This will help patients know more accurately the time they are required to be present for appointments. Outcomes From the data in 2012, the rate of no-shows was 31%. We introduced the Project on Reducing No-shows during 2013 and 2014. We run the project through different phases. We began by defining the size and the scope of the problem. This was followed by the identification of the objectives that the project aimed to achieve. We also analyzed the root and vital causes of high no-show rates. After this phase, we embarked on data collection, which involved more than 1000 patients. We then decided on the most appropriate methods of data analysis. After the implementation of the recommendations of the project, the rate of no shows reduced to 26% in 2014, indicating that more patients attend their pre-scheduled meetings with physicians. References Ball, M. J., Weaver, C. A., & Kiel, J. M. (2004). Healthcare information management systems: cases, strategies, and solutions (3rd ed.). New York: Springer. Barron, G. (2011). Scheduling procedures for a family practice doctors office. New York: JIST Works. Brown, G. D., Stone, T., & Patrick, T. B. (2005). Strategic management of information systems in healthcare. Chicago, IL: Health Administration Press ;. Eder, L. B. (2000). Managing healthcare information systems with Web-enabled technologies. Hershey, Pa.: Idea Group Pub.. Hall, R. W. (2012). Handbook of healthcare system scheduling. New York: Springer. Hasvold, P. E., & Wootton, R. (2011). Use Of Telephone And SMS Reminders To Improve Attendance At Hospital Appointments: A Systematic Review. Journal of Telemedicine and Telecare, 17(7), 358-364. Johnson, B. J., Mold, J. W., & Pontious, J. M. (2007). Reduction and Management of No-Shows by Family Medicine Residency Practice Exemplars. The Annals of Family Medicine, 5(6), 534-539. Liu, N., Ziya, S., & Kulkarni, V. G. (2010). Dynamic Scheduling of Outpatient Appointments Under Patient No-Shows and Cancellations. Manufacturing & Service Operations Management, 12(2), 347-364. Medscape Log In. (n.d.). Medscape Log In. Retrieved July 9, 2014, from http://www.medscape.com/viewarticle/496210 Parikh, A., Gupta, K., Wilson, A. C., Fields, K., Cosgrove, N. M., & Kostis, J. B. (2010). The Effectiveness of Outpatient Appointment Reminder Systems in Reducing No-Show Rates. The American Journal of Medicine, 123(6), 542-548. Ramutkowski, B. (1999). Medical assisting: a patient-centered approach to administrative and clinical competencies. New York: Glencoe/McGraw-Hill. Result Filters. (n.d.). National Center for Biotechnology Information. Retrieved July 9, 2014, from http://www.ncbi.nlm.nih.gov/pubmed/11456244 Volume 2, Edition 2: Clinical No-Show Rates. Is Technology a Contributor?. (n.d.). Divurgent. Retrieved July 9, 2014, from http://divurgent.com/volume-2-edition-2-clinical-no-show-rates-is-technology-a-contributor/ West, K., Hunt, S. A., & Applegate, E. J. (2009). Todays medical assistant: clinical & administrative procedures. St. Louis, Mo.: Saunders/Elsevier. Read More