Abstract
Background The Communicable Disease Center (CDC) Sexual Health Clinic (SHC) faced challenges related to an increasing number of ‘no shows’ for appointments. No-shows reduce provider productivity, increase costs, and limit patient access by reducing effective clinic capacity.1 The appointment system was unorganized (no assigned slot timings and lack of standardized appointment booking flow/process), resulting in inefficient appointment slots and overbooking. These were wastes in the system and costly to the organization. Additionally, the continuous effort to contact ‘no show’ patients overburdens the clinic staff. The aim was to increase CDC SHC appointment slot utilization from 60% to 85% by December-2024.
Methods The team collected baseline data (system-generated and patient feedback) and defined the following measures: percentage of appointment slots utilized in the SHC Clinic (outcome); percentage of no-show patients who were successfully rescheduled (process); and number of slots overbooked (balance). To understand the gaps better, the team brainstormed and created the Fishbone and Driver Diagram. Then, several changes were tested using the Model for Improvement (figure 1). Along with that, the team continued to collect and monitor data to determine the effects of the changes.
Results After testing a few change ideas, there has been a slight improvement in slot utilization (figure 2). However, ongoing monitoring and analysis are crucial to understanding the full impact and sustainability of these changes.
Conclusion Missed appointments were regarded as an important problem. Patient factors rather than practice factors were perceived as most important in causing missed appointments.2 Improving slot efficiency not only enhances patient access to SHC services but also contributed to increased attendance rates, leading to improved diagnosis, early treatment, and prevention of sexually transmitted infections. Continued efforts and adjustments based on data-driven insights will be essential to achieving the set objectives by December 2024.
Plan-do-study-act cycles
Percentage of appointment slots utilized in the sexual health clinic (outcome measure)
References
Huang Y, Hanauer DA. Patient no-show predictive model development using multiple data sources for an effective overbooking approach. Appl Clin Inform. 2014 Sep 24;5(3):836–60. doi: 10.4338/ACI-2014-04-RA-0026.
Husain-Gambles M, Neal RD, Dempsey O, Lawlor DA, Hodgson J. Missed appointments in primary care: questionnaire and focus group study of health professionals. Br J Gen Pract. 2004 Feb;54(499):108–13. No DOI
Ethical Approval/IRB Statement The project was approved by the Executive Leadership of Communicable Disease Center, Hamad Medical Corporation, Qatar.
Disclosures and Acknowledgments The authors of the project would like to acknowledge the leaders and staff of the Communicable Disease Center who were involved in the conceptualization of the project.
