Decreasing No-Show Rates in Radiology

With no-show appointments averaging between 2%–5% in radiology departments, missed appointments are costly to an imaging department. You leave the day with a full schedule and by 2 PM the following day the schedule has more holes than a championship golf course.  

In an effort to get a better understanding of the no-show appointments, Twin Cities Community Hospital utilized lean daily management (LDM). Although we were following no-show rates for all modalities, two areas that were of particular interest were nuclear medicine and ultrasound because of associated isotope costs and OB ultrasound volume.

After gathering data for over one month, two significant findings were made; OB ultrasound appointments did have the highest no-show appointment rates and we uncovered a totally unexpected issue in nuclear medicine, which was related to inpatients. Since we use a nuclear pharmacy company to deliver isotopes, we were experiencing high stat delivery charges because the nuclear medicine technologist was not aware of the inpatient procedure before placing the order. The hospital is located in the Central California Coast and is approximately 200 miles from the nuclear pharmacy, which is located in North Los Angeles.

In further evaluating the data and the processes, we implemented the following which has proved beneficial:

• In doing daily reminder calls we have been able to determine some of the OB patients were admitted to the hospital for delivery. This has allowed those occupied appointments to be used by other outpatients. OB is a major service line at Twin Cities Community Hospital. 

• The labor and delivery unit is delivering a census report in the morning to centralized scheduling which uses it to cross reference outpatient appointments. Appointments occupied by patients on the labor and delivery unit are opened for outpatients.

• After 8 PM, the night shift technologist is to notify the nuclear medicine technologist of any inpatient nuclear medicine procedures so the doses can be ordered by 2 AM.  We have made the notification cutoff at midnight since we have only one nuclear medicine technologist.

• One issue that we discovered and not resolved is when the inpatient order is made for the next day in the electronic medical record, the patient name and procedure is not populating to the modality worklist.

We will continue to follow our no shows utilizing LDM to assess the process improvements we have made over the month of November.

Attention to no-show appointments is constantly at the forefront of a facilities agenda as demonstrated in a recent article.  Insight is provided on the issues departments have with no shows. The authors reference a new study published by the JACRdone at Massachusetts General Hospital which analyzed over 54,000 appointments and found a no show rate of 6.5%. The article is informative and I highly recommend you read it.