Process Improvement Decreases No Show Rates for Pediatric Cardiac CT/MRI Imaging with Anesthesia

1. Process Improvement Decreases No Show Rates for Pediatric Cardiac CT/MRI Imaging with Anesthesia Charles Upshaw, M.D.1, Rebecca Lee1, Catherine Turman3,Andrew Rivard, M.D.1,2 Departments of 1Radiology, 2Cardiology, and 3Nursing University of Mississippi Medical Center, Jackson, MS Introduction Methods Multiple protocol changes were instituted in an attempt to decrease no show rates: Eliminated automated telephone system programmed to call the evening prior to the anesthesia appointment and automated calls for appointment rescheduling Created packet of anesthesia, radiology and NPO instructions sent to the mailing address of the parent. Combined two separate phone calls traditionally made by anesthesia and radiology into one as a single point of verbal instruction done 24 hours prior to the scheduled exam. Coordination of pediatric imaging and anesthesia is a complex logistical challenge. Driving to an unfamiliar hospital location, transportation difficulties, and communication flaws can lead to an appointment no-show. During the formation of a pediatric cardiac imaging program , a high no-show rate was identified. The purpose of the study was optimize pediatric cardiac MRI attendance in the setting of a predominately rural population. Data for 12 consecutive months of no-shows collected by chart review and data for pediatric cardiac imaging appointment attendance was then compared to no-show rates for non-cardiac CT/MRI exams in which above practices were not implemented. Results • No-show rate for cardiac CT/MR studies was 1% (n = 1 of 94 total cardiac exams). • No-show rate for non-cardiac pediatric CT/MRI exams with anesthesia was 9% (n = 175 of 2197 exams). Patient No Shows Conclusion Considerable effort is expended to ensure a successful pediatric cardiac CT/MRI exam, with exam success hinging on presence of the patient. We examined the core issues associated with patient no shows and implemented a standardized three step process to maximize patient/family attendance. We eliminated unnecessary and confusing messages by focusing efforts to communicate meaningful written and verbal information before the scheduled appointment. Our results support this process as evidenced by a 1% no show rate. Informal review revealed that anonymous automated telephone calls were not answered due the assumption that the phone call was related to hospital bill collecting. Also, phone messages were generally not retrieved because of pre-paid mobile phone plans or disconnected land lines, leaving the US postal service as the sole mode of communication.