The Implementation of a No-Show and Cancellation Policy in the Primary Care Setting: Quality Improvement Project
Doctor of Nursing Practice
Susan DeNisco, DNP, APRN, FNP-BC, FAANP
Luis Rojas, DNP, APRN, FNP-BC
The purpose of this quality improvement project is to evaluate the implementation of a no-show and cancellation policy in an urban out-patient primary care setting. The high occurrence of patient no-shows and cancellations in primary care settings is a persistent problem affecting how efficiently healthcare is delivered. No-shows occur when a patient makes an appointment and does not attend the appointment. It diminishes the practice opportunity to schedule other patients in the missed appointment time slot, thus leading to a loss of revenue. It tends to affect practice resource allocation, thereby worsening the quality of healthcare services. The current problem at a private cardiovascular and primary care office in Southern Connecticut is they have a 21% not show rate without a No-Show policy in place. This project aims to implement a standardized No-show policy in the office’s primary care division. Implementing a no-show policy will improve the patient care experience which includes quality and satisfaction. It will indirectly improve the overall health of the population while simultaneously helping to reduce the cost of health care, in line with the triple aim objective. To assess the effect of the new policy, no-show, cancellation, and rescheduling data were retroactively analyzed from October 1st, 2021, to February 28th, 2022, and compared to data from 2019. The practice reported 526 (21%) No-Show occurrences and 2980 cancellations in 2019. With the industry standard of $200 per missed appointment, the practice lost $701,200 in revenue for 2019. There were 2635 scheduled appointments during the quality improvement phase, with 791 (30%) cancelations and 241(9%) no-shows. This represents a decrease in the no-show rate. Limitations included retrospectively data analysis. The results might not be applicable to other settings. Providers can use scheduling data from the EHR to improve patient care and reduce costs, through efficient scheduling practices. By auditing EHR data, providers can access patients’ no-show and cancellation history building predictive models to assess patient’s no-show probability to improve resource efficiency, and patient outcomes while decreasing loss of revenue.
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Hall, D. (2022). The implementation of a no-show and cancellation policy in the primary care setting: Quality improvement project [Unpublished DNP project]. Sacred Heart University.
A DNP project submitted in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice, Sacred Heart University Davis & Henley College of Nursing.