Transcript Process Improvement Decreases No Show Rates for Pediatric

Process Improvement Decreases No Show Rates for Pediatric Cardiac CT/MRI Imaging with Anesthesia
1
M.D. ,
1
Lee ,
3
Turman ,
Charles Upshaw,
Rebecca
Catherine
Andrew Rivard,
1
2
3
Departments of Radiology, Cardiology, and Nursing
University of Mississippi Medical Center, Jackson, MS
1,2
M.D.
Introduction
Methods
Coordination of pediatric imaging and anesthesia is a complex
logistical challenge. Driving to an unfamiliar hospital location,
transportation difficulties, and communication flaws can lead to
an appointment no-show. During the formation of a pediatric
cardiac imaging program , a high no-show rate was identified.
Multiple protocol changes were instituted in an attempt to
decrease no show rates:
The purpose of the study was optimize pediatric cardiac MRI
attendance in the setting of a predominately rural population.
1. Eliminated automated telephone system programmed to call
the evening prior to the anesthesia appointment and
automated calls for appointment rescheduling
2. Created packet of anesthesia, radiology and NPO instructions
sent to the mailing address of the parent.
3. Combined two separate phone calls traditionally made by
anesthesia and radiology into one as a single point of verbal
instruction done 24 hours prior to the scheduled exam.
Data for 12 consecutive months of noshows collected by chart review and data
for pediatric cardiac imaging appointment
attendance was then compared to no-show
rates for non-cardiac CT/MRI exams in
which above practices were not
implemented.
Results
No-show rate for cardiac CT/MR studies was
1% (n = 1 of 94 total cardiac exams).
Patient No Shows
No-show rate for non-cardiac pediatric
CT/MRI exams with anesthesia was 9%
(n = 175 of 2197 exams).
Conclusion
Considerable effort is expended to ensure a successful pediatric
cardiac CT/MRI exam, with exam success hinging on presence of
the patient. We examined the core issues associated with
patient no shows and implemented a standardized three step
process to maximize patient/family attendance.
We eliminated unnecessary and confusing messages by focusing
efforts to communicate meaningful written and verbal
information before the scheduled appointment. Our results
support this process as evidenced by a 1% no show rate.
Informal review revealed that anonymous automated telephone
calls were not answered due the assumption that the phone call
was related to hospital bill collecting. Also, phone messages
were generally not retrieved because of pre-paid mobile phone
plans or disconnected land lines, leaving the US postal service
as the sole mode of communication.