To Show or Not to Show: Improving Nutrition Clinic

Attendance
Rebecca Heming, Dietetic Intern; Austin Shelly, RD; Angie Hasemann Bayliss, MS, RDN, CSP
University of Virginia Health System, Charlottesville, VA
INTRODUCTION METHODS
❖ No-shows are a common problem for dietitians, especially those working in outpatient ❖ A review of the current evidence on no-show rates was performed.
or private practice settings.
❖ Data was collected from EPIC on NCC’s no-show rates over the past seven months was
o No-shows are defined as patients who do not arrive for their appointments and do
reviewed.
not call ahead of time to cancel or reschedule.
❖ Meetings were held with the NCC team to determine which evidence-based practices
❖ The adverse effects of no-shows include loss of revenue and a resultant increase in
would be best to implement first.
healthcare costs, increased wait times, staffing challenges, decreased access to care, ❖ A multi-pronged strategy was developed which utilizes logistical and dietitian specific
and reduced clinic efficiency.1.2 skills.
❖ Furthermore, patients are more likely to have worse outcomes due to lack of o A clear no-show policy was produced and added to EPIC to be sent to patients who
continuity of care, reinforcement, and individualization of treatment.1,2 missed two appointments.
❖ Little data exists of no-show rates specific to dietitians.
o An agenda map was created to be used in session with clients to clarify their goals and
BACKGROUND
determine which topics should be addressed at the next appointment.
❖ The Nutrition Counseling Center at Northridge (NCC) had a combined cancellation and o A patient feedback card was constructed to guide future improvement initiatives.
no-show rate of 41% from May through February 2019, with more initial visits no- o Patient success stories were collectedRESULTS
to create marketing materials to attract new
showing compared to follow-ups. clients.
NCC Initial Appointment Combined No-Show & Cancellation Rate NCC Follow-Up Appointment Combined No-Show & Cancellation Rate
52% 54% Agenda Map No-Show Policy Patient Feedback
51% 50% 51%
44% 47% 43% 44% 43% Card
38% 38%37%  The agenda maps  Despite
30%
35% 36% 36%  Patients who no-show or
28% 28%30%
continue to be cancel with less than 24 encouragement
tweaked to best hours notice three times from the NCC team,
Percentage

Percentage

meet clients needs. will no longer be few patients fill out

 NCC RDs feel that scheduled. the patient feedback
the agenda maps  The entire NCC team has cards.
are a positive established a clear  The NCC team is
Month Month addition to patient consensus on no-show working together to
sessions. policy usage. devise a plan to
CONCLUSION & NEXT STEPS foster participation.
❖ Factors that affect no-show rates:
o Demographics - younger patients and minorities are more likely to no-show. 3 ❖ No-show rates are inherently driven by numerous complex factors.
o Clinic Specifics - most importantly: lead time, distance to clinic, and providers ❖ Although no-shows cannot be entirely eliminated, dietitians have multiple potential
experience level.3 avenues to improve no-show rates.
o Patient Specifics - emotions, insurance status, diagnosis, and previous missed ❖ More research needs to be performed on dietitians no-show rates to develop best
appointments.3 practices.
o Others - to
❖ Strategies forgetfulness, risk perception,
improve no-show rates: reluctance to attend appointments. 4 ❖ During the course of this project, the cancellation rate at NCC has risen whereas the no-
o Logistics - reminders, scheduling practices, telemedicine, no-show policy show rate has fallen. It is important to more narrowly define the term “cancellation” and
development. perhaps also implement a cancellation policy.
❖ Many of NCC’s patients are referred by other providers, therefore another potential
o Financial - pricing strategies, fees, use of health motivators.5
avenue to improve the bottom line is to track the number of referrals received, increase
o Dietitian Specific Skills - counseling skills, communication, behavioral contracts, other providers knowledge about NCC, and examine processes to increase referrals.
individualization, patient education tactics.5
REFERENCES
PURPOSE
1.Myers EF, Heffner SM. Strategies for Improving Follow-Up Client Appointment-Keeping Compliance. Journal of the
Academy of Nutrition and Dietetics. 2001;101(8):935-939. doi:https://doi.org/10.1016/S0002-8223(01)00232-2.
❖ To evaluate the contributing factors leading to no-shows at NCC. 2.McMullen MJ, Netland PA. Lead time for appointment and the no-show rate in an ophthamology clinic. Clinical
❖ To use this information to create an action plan for NCC that utilizes best practices and Ophthalmology. 2015;9:513-516.
3. Dantas LF, Fleck JL, Cyrino Oliveira FL, Hamacher S. No-shows in appointment scheduling – a systematic literature
patient and provider feedback to improve no-show rates. review. Health Policy. 2018;122(4):412-421. doi:https://doi-org.proxy01.its.virginia.edu/10.1016/j.healthpol.2018.02.002.
❖ To reduce the number of no-shows and cancelations at NCC ideally from an average of 4. Spikmans FJM, Brug J, Doven MMB, Kruizenga HM, Hofsteenge GH, van Bokhorst-van der Schueren MAE. Why do
41% to an average of 30% or less within the next calendar year. diabetic patients not attend appointments with their dietitian? Journal of Human Nutrition and Dietetics . 2003;16:151-
158.
5. Myers EF, Heffner SM. Strategies for Improving Follow-Up Client Appointment-Keeping Compliance. Journal of the
Academy of Nutrition and Dietetics . 2001;101(8):935-939. doi:https://doi.org/10.1016/S0002-8223(01)00232-2.