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Missed appointments: why we need to care 

Written By: Heather Cresswell, NP

 

Patients are frustrated by long wait times for medical appointments. Yet, 10-20% of patients miss appointments every day? Is there a better way? 

On the surface, a no-show for a medical appointment may seem like a welcome break in the schedule for busy clinic staff. But last-minute missed appointments do have an impact. For example, missed appointments can contribute to the following problems:

  • Patients don’t get necessary medical care, leading to delayed diagnosis and treatments;
  • Healthcare teams experience added workload to notify, contact, reschedule and update families and providers
  • Longer wait times occur as missed appointments need to be rebooked and new patients need to wait longer to be seen
  • Additional resources are required to support the additional workload and longer clinic times

There are multiple reasons why families may miss their appointments. These include patient characteristics such as age, living alone and marital status but also include systemic barriers that prevent families from attending their appointments.  Income is a barrier to attending appointments when it affects the patient’s ability to take time off work, arrange transportation and find suitable child care when necessary. Other systemic barriers that contribute to missed appointments include how families are notified, how they connect and attend their appointments and how they can schedule, reschedule and cancel their appointments. 

Making it better: It’s not us versus them

Human nature may bias us towards an “us versus them” perspective when it comes to missed appointments. Patients are fed up with wait times. Providers are irritated, knowing that someone else could have used an empty appointment, and a missed appointment adds to wait times. 

There is a better way to look at the systemic issue of missed appointments. It’s time to harness existing resources and systems to improve Ontario’s healthcare to benefit patients and providers alike. 

Can we make our system better for patients? The answer is yes- the Ontario healthcare system should be modernized and designed to reduce barriers to patient care. 

Use modern software solutions 

Clinical management software options are readily available in Canada. These systems can facilitate seamless communication with referring and consulting providers and shift booking accountability from the provider to the patient. 

Our current system is outdated and broken. Once a patient has been referred to a specialist, they have no recourse other than to wait to be notified of their appointment time. They have little choice in choosing their provider and there are barriers to scheduling, rescheduling and cancelling appointments. It stands to reason that giving patients some degree of choice and agency in the appointment booking process will reduce the need to reschedule or miss the appointment entirely. Empowering patients and giving them agency is always a good idea. 

Use reminders, but consider a customized approach

Giving patients options for how they receive reminders may make them more effective. Certainly, text notifications are likely preferred by many, but some may be better served with a phone call or email. Again, we can give patients choices and design a modern software solution that improves how families are notified. This system may include choice but should also be based on verified communication. 

Extra reminders may be in order if you can track missed appointments and identify patients who seem repeatedly challenged to keep appointments. Tarabichi et al. shared a significant reduction in no-shows with a customized approach. 

Leave some availability for same-day or next-day bookings

The further in advance an appointment is booked, the higher the chance of a no-show. Patients may forget about the appointment and overbook their day or find a provider who can see them sooner. Depending on the practice, it may be feasible – and a good idea – to leave a proportion of appointments available for short turnarounds. 

Be reachable

Data collected by the Faculty of Medicine, University of Montreal, indicates that almost 20% of no-shows tried but could not reach the clinic they were supposed to attend or could not leave a voice message. Phone availability is a start, but online portals offer even more accessibility. You can’t expect your patients to cancel well in advance if they can’t reach your administration staff or leave a message. 

Missed appointments hurt everyone. If we implement strategies that value the time of both the provider and the patient, we all win.

Resources

  1. Glauser, W. (2020). When patients miss appointments, everyone pays. CMAJ. [Accessed September 2024]
  2. Claveau, J. (2020). Patients’ missed appointments in academic family practices in Quebec. Canadian Family Physician. [Accessed September 2024]
  3. Shahab, I. & Meili, R. (2019). Examining non-attendance of doctors appointments at a community clinic in Saskatoon. Canadian Family Physician. [Accessed September 2024]
  4. Alturbag, M. (2024). Factors and reasons associated with appointment non-attendance in hospitals: A narrative review. Cureus. [Accessed September 2024] 
  5. Dantas, L. et al. (2018). No-shows in appointment scheduling – a systematic literature review. Health Policy. [Accessed September 2024]

Tarabichi, Y. et al (2023). Reducing disparities in no-show rates using predictive model-driven live appointment reminders for at-risk patients: A randomized controlled quality improvement initiative. Journal of General Internal Medicine. [Accessed September 2024]