In the realm of anesthesia and surgical services, patients who miss appointments create significant challenges for medical practice management. Colloquially known as “no-shows”, these patients contribute to a host of practitioner staffing and cost issues. No-shows can hinder an effective and cost-conscious practice when surgeons, anesthesiologists, and certified registered nurse anesthetists (CRNAs) need to be rescheduled to accommodate a missed appointment. For surgical services and anesthesia management, it is essential to understand the etiology of the no-show, and to be knowledgeable about current interventions used to address the issue of missed appointments. Promising technological innovations are developing on the horizon that offer a possible avenue toward mitigating the impact of no-shows on medical practices nationwide.
From the patient perspective, there are several reasons why an individual may not show up to a scheduled surgery appointment. A recent article from BMC Health Services Research on the psychology of no-show patients explores these reasons in great detail. In an effort to understand no-shows, health economist researchers implemented a retrospective, cross-sectional study, which included variables such as patient demographics, time, healthcare provider, and type of operation in order to ascertain the most frequent reasons for cancellation. Researchers found that among approximately n=500 study subjects, “scheduling issues”, “patient reporting sickness on appointment date”, and “specialized clinical procedures” were the highest reported reasons for cancellation. This study has prompted future research into interventions for these high-frequency cancellation factors.
The cited factors for patient cancellation can be attributed to the patient or the provider. We have seen how the increasing prevalence of Anesthesia Information Management Systems (AIMS) combined with electronic health or medical records (EHR, EMR), has improved the capacity of practices, hospitals, and health centers to mitigate scheduling issues experienced by patients. But how can anesthesia management address cancellation issues involving a patient feeling unwell, or feelings of uncertainty surrounding specialized clinical procedures? One possible solution involves improved communication between patients and providers, facilitated by novel technology mechanisms such as patient engagement tools. These tools typically take the form of applications (apps), which are seamlessly integrated into mobile technologies. These apps can send basic communications to the patient, such as information pertaining to a patient’s pre-surgery regimen, as well as specific text reminders that include appointment dates, times, and locations. Moreover, these rapidly advancing patient engagement apps can help minimize no-shows by creating a portal for patients to instantly communicate with their healthcare provider, or their provider’s administrative representative. If a patient doesn’t feel they have enough information about a procedure the evening before, app portals can connect the patient to a knowledgeable representative or online source to acquire more information. If the patient feels unwell, there is a messaging function on the app that allows that patient to inform their provider prior to the day of the appointment. Many companies are taking advantage of these technologies to help decrease the communication gap between patient and provider, improving anesthesia and surgical management along the way. Most importantly, there is growing evidence to back the efficacy of these tools. A preliminary health system study reported that a text-based tool intervention reduced patient no-shows by over 66%, a notable and significant finding.
As patient engagement technologies develop, anesthesia and surgical services management should take note of interventions that have the potential to reduce patient no-shows and to improve the patient-provider relationship. Patient engagement technologies are just one example of how modernizing medicine can have a significant impact on the ways in which individuals experience healthcare, as well as the ways in which providers support patients on their surgical journeys.
- Da’Ar, Omar B., and Talal Al-Mutairi. “How Do Patient Demographics, Time-Related Variables, Reasons for Cancellation, and Clinical Procedures Affect Frequency of Same-Day Operating Room Surgery Cancelation? A Maximum Likelihood Method.” BMC Health Services Research, vol. 18, no. 1, 2018, pp. 1–9., doi:10.1186/s12913-018-3247-y
- Roeder, Jacqueline A. “The Electronic Medical Record in the Surgical Setting.” AORN Journal, vol. 89, no. 4, 2009, pp. 677–686., doi:10.1016/j.aorn.2008.12.027.
- Garvin, Lynn A and Steven R Simon. “Prioritizing Measures of Digital Patient Engagement: A Delphi Expert Panel Study” Journal of Medical Internet Research vol. 19,5 e182. 26 May. 2017., doi:10.2196/jmir.4778
- Siwicki, Bill. “Text-Based Tool Reduces Patient No-Shows by More than Two-Thirds.” Healthcare IT News, HIMSS, 2018,