title: Improving Nonattendance at Outpatient Pediatric Endoscopy Unit of a Tertiary Center.
abstract: OBJECTIVE
  Failure to attend pediatric outpatient endoscopic procedures leads to inefficient use of resources, longer wait-list times, and delay in diagnoses. The causes for pediatric endoscopy nonattendance are not well studied. The aim of the study was to identify factors associated with failure to attend endoscopic procedures and to assess the value of quality improvement (QI) interventions implemented to improve pediatric endoscopy attendance.
  
  
  METHODS
  This was a continuous QI project. We collected nonattendance data from November 2011 to November 2013. Information collected included procedure type, age, sex, time on the waiting list, history of previous procedures, and reason for nonattendance. The following QI interventions were implemented sequentially: an appointment reminder letter, a telephone call 1 week before procedure, and creation of an electronic medical note dedicated to endoscopy appointment. Pareto charts and statistical process control charts were used for analysis.
  
  
  RESULTS
  From November 2011 to November 2013, we were able to decrease nonattendance from 17% to 11% (P = 0.005). No-show rate was reduced from 5% to 0.9% (P = 0.00001). There was no significant difference between attendees and nonattendees in relation to sex, age, or having a previous procedure. Longer waiting time (33 vs 26 days) was associated with increased risk for nonattendance (P = 0.0007). The most common causes for nonattendance were illness (31.5%), followed by caregiver/patients who no longer wanted the procedure (17.7%), and patients who improved (12.9%).
  
  
  CONCLUSIONS
  Applying QI methods and tools improved pediatric endoscopy attendance. Longer wait time for endoscopic procedures is associated with nonattendance. Given the increased pediatric endoscopy demand, strategies should be implemented to reduce wait time for pediatric endoscopy.
authors: Division of Pediatric Gastroenterology and Nutrition, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY.
authors: Debora
authors: D
authors: Kogan-Liberman
authors: Yolanda
authors: Y
authors: Rivas
authors: John
authors: J
authors: Thompson
authors: Gitit
authors: G
authors: Tomer
mesh_terms: D000293:Adolescent; D001071:Appointments and Schedules; D002648:Child; D002675:Child, Preschool; D003113:Colonoscopy; D004724:Endoscopy; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D008297:Male; D000067455:No-Show Patients / Q000706:statistics & numerical data*; D010045:Outpatients; D010372:Pediatrics; D062606:Tertiary Care Centers; D013997:Time Factors