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Abstract Details

Quantifying the burden of unfilled clinic appointment slots created by late-notice cancellations
General Neurology
P3 - Poster Session 3 (5:30 PM-6:30 PM)
4-077
This quality improvement (QI) project aims to 1) quantify the burden of late cancellations at a large academic institution’s neurology outpatient clinics and 2) evaluate their key drivers.  

Late notice, patient-initiated cancellations are an under-recognized cause of limited access to care. While the “no-show” literature is robust, late cancellations are a difficult metric to capture and lead to a paucity of data on their prevalence and impact.  Open slots due to late cancellations are difficult and time consuming to fill and are often left unoccupied. They lead to fewer total available appointments and increased wait time to the next open slot. 

 
Our team extracted 6 months (Jan-June’18) of appointment booking data from the electronic health record (EHR) and our patient scheduling call centers, with slots retroactively subdivided into filled, cancelled, cancelled late, no-show. We also observed our cancellation call workflow and introduced an optional end-of-call survey to directly query our patients on factors leading to them not keeping their appointment.
From our 6-month data, an average of 14.5+0.9% of clinic appointments (mix new/return) were left unfilled due to late cancellations This is as compared to the 5+0.4% average no-show rate in the same timeframe. Late cancellations represented almost half (46%) of all cancellation calls made. Our survey revealed many unalterable factors for cancellation, but also found transportation and inconvenient technology for cancellation (e.g. calling during business hours) as possible intervenable pain points. 
Cancellations, and particularly those with late notice (<7 days), decrease clinic efficiency by up to 15% and place a tremendous processing burden on clinic staff.  Addressing cancellations, and not just no-shows, is thus our next aim in improving our patients’ access to subspecialty neurological care.
Authors/Disclosures
Hilary H. Wang, MD (Swedish Health Services)
PRESENTER 		Dr. Wang has nothing to disclose.
No disclosure on file
Laurice T. Yang, MD, MHA, FAAN The institution of Dr. Yang has received research support from Alzheimer's Disease Research Center (ADRC). The institution of Dr. Yang has received research support from Pacific Northwest Udall Center . The institution of Dr. Yang has received research support from Biogen/Parkinson's Study Group . The institution of Dr. Yang has received research support from Eli Lily . The institution of Dr. Yang has received research support from Michael J. Fox Foundation For Parkinson's Research . The institution of Dr. Yang has received research support from Sanofi . Dr. Yang has received personal compensation in the range of $500-$4,999 for serving as a Chair, Workgroup with 好色先生 .