For anesthesia and surgical service practice managers, patients who miss appointments create significant challenges. Often referred to as “no-shows”, such patients can cause provider staffing issues and unnecessary costs for practices downstream. No-shows can interfere with an effective and cost-conscious practice when surgeons, anesthesiologists, and certified registered nurse anesthetists (CRNAs) need to be rescheduled in order to accommodate a missed appointment. If we want to successfully address this issue, it is critical to understand the psychology of no-show patients, and to be cognizant of the modern interventions available to mitigate no-show events. Promising technological innovations offer a possible avenue toward minimizing the impact of no-shows on surgical practices throughout the U.S.
The etiology of patients who miss appointments is an important area of study that is highly under-researched. A study published in BMC Health Services Research on the psychology of no-show patients delves into this topic in great detail. In an effort to understand no-shows, the research team conducted a retrospective, cross-sectional study, investigating variables such as patient demographics, time, healthcare provider, and type of operation in order to evaluate the most frequent reasons for cancellation among patients. The researchers concluded that throughout the study, “scheduling issues”, “patient reporting sickness on appointment date”, and “specialized clinical procedures” were the highest reported reasons for cancellation. This study has prompted future research into interventions for these high-frequency cancellation factors.
The cited factors for patient cancellation can be analyzed on both the patient side and the provider side. We have seen how the rising utilization of Anesthesia Information Management Systems (AIMS) combined with electronic health or medical records (EHR, EMR), has improved the ability of practices, hospitals, and surgical centers to deal with patient scheduling issues. However, cancellation factors involving a patient’s state of being or knowledge of their procedure are infrequently addressed. One possible solution to the more nuanced cancellation factors is enhanced communication between patients and providers, facilitated by modern technology mechanisms such as patient engagement tools. These tools commonly take the form of applications (apps), which are seamlessly integrated into digital devices. Patient engagement apps can communicate basic information to the patient, including specific instructions about the patient’s pre-surgical regimen, as well as text reminders with appointment dates, times, and locations. Furthermore, these swiftly advancing patient engagement apps can help minimize no-shows by creating a direct line of communication between patients and providers, or a provider’s administrative representative. If a patient doesn’t feel they have enough information about the procedure prior to their appointment, an app can help connect the patient to a knowledgeable representative or online source to access more information about the procedure. If the patient is dealing with an illness that is unrelated to their procedure, an app can include a messaging function that allows the patient to inform their provider ahead of the appointment. Many platforms are currently in development, improving anesthesia and surgical management as they become utilized. Furthermore, there is growing evidence to back the efficacy of these tools. A recent study concluded that a text-based tool intervention reduced patient no-shows in a particular health system by two-thirds, a notable and statistically significant finding.
As platforms for reducing patient no-shows and improving communication systems continue to advance, anesthesia and surgical services management should take note of these interventions for use in their own systems. Patient engagement technologies are just one example of how the modernization of medical practices can influence interactions between providers and patients, and have a profound affect on a patient’s experience throughout their healthcare journey.
- Da’Ar, Omar B., and Talal Al-Mutairi. “How Do Patient Demographics, Time-Related Variables, Reasons for Cancellation, and Clinical Procedures Affect Frequency of Same-Day Operating Room Surgery Cancelation? A Maximum Likelihood Method.” BMC Health Services Research, vol. 18, no. 1, 2018, pp. 1–9., doi:10.1186/s12913-018-3247-y
- Roeder, Jacqueline A. “The Electronic Medical Record in the Surgical Setting.” AORN Journal, vol. 89, no. 4, 2009, pp. 677–686., doi:10.1016/j.aorn.2008.12.027.
- Garvin, Lynn A and Steven R Simon. “Prioritizing Measures of Digital Patient Engagement: A Delphi Expert Panel Study” Journal of Medical Internet Research vol. 19,5 e182. 26 May. 2017., doi:10.2196/jmir.4778
- Siwicki, Bill. “Text-Based Tool Reduces Patient No-Shows by More than Two-Thirds.” Healthcare IT News, HIMSS, 2018, www.healthcareitnews.com/news/text-based-tool-reduces-patient-no-shows-more-two-thirds.