Reducing Missed Mental Health Appointments: A Telehealth Clinic Quality Improvement Project

BACKGROUND: A patient's failure to attend scheduled follow-up appointments significantly impacts patient outcomes, healthcare costs, outpatient clinical revenue, and productivity. No-call and no-show appointments cost the United States healthcare system more than 150 billion dollars annually. There has been significant research on the causes and possible interventions to decrease the number of no-call and no-show appointments; many have demonstrated a substantial improvement with reminders.

LOCAL PROBLEM: This quality improvement project setting is a mental health outpatient clinic providing telehealth services throughout a northeastern state. All services are provided using a custom-built platform with an in-session charting system. This project aims to implement a person-to-person reminder to decrease the number of patients who fail to attend their scheduled mental health appointments.

METHODS: The Model for Improvement (MFI) guides the project. A person-to-person reminder call is provided to the patient one business day before the appointment. A spreadsheet was maintained to identify the number of contacts, unsuccessful contacts, and rescheduled or canceled appointments. A comparison of pre-intervention and post-intervention show rates was presented after three months of implementation. A chi-square test is used to identify the difference between the observable and expected data chance or relationship between pre- and post-intervention.

INTERVENTIONS: The intervention was implementing a person-to-person reminder call one business day before the scheduled appointment. Patients who could not attend their scheduled appointments were assisted with rescheduling.

RESULTS: The number of no-show appointments decreased from 16.5% to 15.9% across the organization after implementation of the person-to-person reminder. A Chi-square test was completed using SPSS, and the difference between pre- and post-intervention was statistically significant. This quality improvement project yielded an 86% attendance rate from 81% the previous year.

CONCLUSION: A person-to-person reminder successfully decreased the number of no-show appointments, increased the possibility for provider productivity, and increased the potential for financial revenue.