Journal Article

35 Improving efficiency of outpatient consultations by reducing no-show numbers

van der Glas-Schmidt, Fiona, Reijerink, Ewald, Massolt, Elske T, Ernst-Jan van de Weijgert

2025

Overview

IntroductionThe quality and accessibility of the Dutch healthcare system are under increasing pressure. There is a growing demand for healthcare services due to factors like an ageing population and an increase in the number of chronically ill people. Unfortunately, we also have to deal with a chronic staff shortage. One of the solutions is a greater efficiency aiming at providing more healthcare with the same amount of resources and numbers of staff. In 2023, 6.4% of our patients (which means 3314 patients) did not come to their appointment on the outpatient clinic (no show).AimOur aim was to improve the attendance to the clinic to increase efficiency and save costs.We analysed the distribution of no-show patients among the internal medicine subspecialties. 3.3% of the oncology patients, 4.7% of the haematology, 4.7% of the nephrology and 9.2% of the endocrinology patients did not show-up.InterventionsAlmost all our patients have to draw blood before an appointment. Patients who do not visit the lab usually do not come to their appointment as well. We hypothesized that a possible intervention could be to call these patients to remind them on their appointment.To deal with staff shortage, we introduced Robotic Process Automation (RPA). Patients can schedule their appointments without intervention from hospital employees through RPA. They receive a lab form via their electronic patient record (mijn ASZ) with instructions. Medical assistants check if lab results are present a few days before the scheduled appointment. A telephone team was established in July 2024 to call patients with missing lab results in the evening. They were asked to draw blood and were reminded on their appointment. We measured no-show numbers monthly, before and after our intervention and performed a student’s T-Test.ResultsFrom July –December 2024 our telephone team reached 1746 (61.2%) patients and left a voicemail for 878 (30.7%) patients. 230 (8.1%) patients were not reached at all. Reported reasons for not drawing blood: lack of a computer or login codes, not having received lab forms, difficulty accessing lab forms or being unaware of the appointment.We measured a significant reduction of no-show numbers after our intervention (N=1558 in Q 3+4 2023 versus N=1168 in Q 3+4 in 2024; p< 0.005, table 1). We calculated that our outpatient clinic capacity increased with 97.5 hrs. We calculated that we gained € 117.000 by reducing no-show numbers, while the costs of the telephone team were € 13.995.Abstract 35 Table 1No show numbers before (quarter 3+4 2023) and after (2024) intervention * p<0.005 Q 3 + 4 2023 Q 3 + 4 2024 Total patients (N) 25057 30226 No-show patients (N): 1558 (6%) 1168 (4%)* −390 (−25%) • New patients (N) 208 147 −61 (−29%) • follow-up patients (N) 1350 1021 −329 (−24%) ConclusionsNo-show numbers can be reduced with a special telephone team and appropriate selection of patients. RPA can help to improve processes in health care, but we have to keep in mind not all patients are digitally skilled.

• Publisher: BMJ Publishing Group LTD
• Subject: Efficiency / Intervention / Labor shortages / Outpatient care facilities