Missed Appointments: Factors Contributing to Patient No-Show in Outpatient Hospital Clinics in Tehran, Iran

Abstract

Background and Objectives:Patient no-show in scheduled appointments is a major challenge for outpatient clinics. It negatively affects the efficiency, accessibility, and delivery of healthcare. This study was conducted to investigate the prevalence and potential predictors of patient no-show in outpatient clinics of a general and teaching hospital in Tehran, Iran. Methods: In this cross-sectional study, all outpatients who had scheduled appointments from March 20, 2016 to March 20, 2017 were included in the study (N = 148,077). Independent two-sample t-test and the Chi-square test were used for comparing the variables in the two groups-attending and no-show patients. Logistic regression was used to analyze predictors of no-show. Results: The no-show rate was 50.1%. General practice (80.3 %) and nephrology (40.1%) clinics had the highest and the lowest noshow rates, respectively. The mean lead time of appointments was 10.2 (± 14.7) days, while the average lead times for no-show and attending patients were 11.7 (± 15.6) and 8.8 (± 13.7) days respectively (P < 0.001). Lead-time of more than two weeks (OR = 1.80), web-based appointment system (OR = 1.71), interactive voice response appointment system (OR = 1.69), month of appointment (OR = 1.03), and clinic working shift (OR = 0.94) were the predictive variables of patient no-show. Conclusions: Findings indicate that appointment lead time is the main predictor of no show. Therefore, deploying strategies to reduce lead time, such as increasing the number of physicians, increasing working hours, or improving clinic efficiency can improve patient attendance. Other findings suggest that appointment reminders via text message, cancellation policy, and nurse-led telephone triage can be expected to decrease patients no-show.

Prevalence and factors associated with missed hospital appointments: a retrospective review of multiple clinics at Royal Hospital, Sultanate of Oman

“…In the USA, it is estimated that 5%-55% of hospital appointments are missed. [2][3][4] In the UK, 1 in 10 outpatient appointments are missed annually in the National Health Service. 5 A missed hospital appointment affects work flow, reduces patient and staff satisfaction and can lead to a loss in revenue as well as having a negative impact on patient's health.…”

After COVID-19: Improving the Patient's Outpatient Appointment Experience

“…Similarly, previous research calculated missed appointment rates between a wide range of 5% to 55%. [1][2][3][4] Boyer 38 and Medical Group Management Association (MGMA) 39 claim current benchmarks for national no-show rates in primary care are 19%. The missed appointment rate in this study was 5.5%, which aligned with the lower end of the missed appointment percentage range in missed appointment rate research and much lower than the MGMA's benchmarks.…”

“…This research suggests to healthcare administrators that the complex, multifaceted origins surrounding missed appointments are vast and definitive solutions are slim. 1,[6][7][8] However, regardless of all the efforts and energy dedicated to the missed appointment dilemma, it continues to be a major concern, This concern should only increase as the COVID-19 pandemic diminishes because patients who have deferred treatment will probably seek more outpatient appointments. 9 Visits to primary care providers dropped by 21% during COVID-19.…”

“…The range of these rates remains constant between 5 to 55. [1][2][3][4][5] Previous missed appointment research has provided healthcare administrators with some tools and resources dedicated to decreasing missed appointment rates. For example, there is research exploring predictive methods, classification models, exploratory explanations, impacts surrounding missed appointments, and the development of countless administrative strategies used to reduce missed appointment rates.…”

Interpretation of Patients’ Location Data to Support the Application of Process Mining Notations

“…The so-called "no-shows" or "missed appointments" concept is a costly defect for patients and healthcare organization. According to the article published in (Anisi et al, 2018), the ratio of the missed appointments is about 34 % only in the USA, and each missed appointment costs about 100 $. One of the major causes behind this issue is the structural problems of the healthcare processes.…”