Patient No-Show in General Pediatrics Ambulatory Clinics: A Pathway to Identify Contributing Aspects, Qatar
Ms. Amina Alansari, Dr. Manasik Hassan, Dr. Ahmed Alhammadi, Mr. Ahmed Almohanadi
mhassan17@hamad.qa

Introduction and aim:
Patient no-show in the clinics represents a critical and difficult problem in the healthcare system. It creates a negative impact in many aspects: disruption in continuity of patient care, complications with their chronic illnesses, long waiting times for new patients, waste of clinic and hospital resources, decreased access to care and reduced clinic efficiency and provider productivity. Our aim was to explore why patients may not show for their appointments and to make potential recommendations based on evidence to decrease the non-attendance rate.

Methods:
This was a prospective study of patients referred to general pediatrics clinics from June 2018 - Sept 2018, using a phone interview-based survey conducted in the general pediatric outpatients’ clinics at Sidra Medicine–the newly opened tertiary children’s hospital in Qatar. All patients that had no-shows to the clinics were screened by the unit clerk of clinics. Survey questions included details from patients exploring different reasons for not attending clinics, although previously patients’ families had confirmed attendance by phone call reminders.

Results:
A total of 2036 patients were scheduled to general pediatric clinics. A total of 883 attended the clinics, 899 canceled / re-scheduled the appointments and 254 were no-shows. The phone interview included 254 out of 1140 of all patients confirmed initially attending clinics in a phone call reminder before appointment. The number of follow up referrals with no shows was 159 (62%) and the number of new referral patients with no shows was 97 (37%). The mainreasons identified of not showing up on phone call back after the clinic’s appointment were: no answer of the call back 143 out of 256 (55%) times, the time of clinics is not suitable with parents = 44 (17%), parents forget the appointment = 26 (10%); other less significant reasons included family work issues (5%), patients/parents were sick (4%), patients clinically improved (3%), no available transportation (3%), patients/parents had school /college exams (3%).

Discussion and Conclusion:
The international benchmark for primary care clinics of no-shows is 10%. In our study, the no show rate was 20%. We identified multiple reasons of no shows similar to the international ones. Initiating new strategies to decrease no-show in the clinics like revisiting the cancelation policy, modifying working hours, nurse-led telephone triage, appointment reminders via sending telephone messages with the option of choice of appointments timing or cancellation/re-schedules will decrease patients’ waiting time, reduce health care cost and maintain full capacity scheduling of the clinics.

Take Home Message:
Better appointment flexibility and communication will reduce the no-show rate in outpatient clinics.