The role of a nurse telephone call to prevent no-shows in endoscopy.
OBJECTIVE
Preventing missed appointments, or "no-shows," is an important target in improving efficient patient care and lowering costs in gastrointestinal endoscopy practices. We aimed to investigate whether a nurse telephone call would reduce no-show rates for endoscopic appointments, and to determine if hiring and maintaining a nurse dedicated to pre-endoscopy phone calls is economically advantageous. Our secondary aim was to identify predictors of no-shows to endoscopy appointments.


METHODS
We hired and trained a full-time licensed nurse to make a telephone call to patients 7 days before their scheduled upper endoscopy or colonoscopy. We compared this intervention with a previous reminder system involving mailed reminders. The effect of the intervention and impact of other predictors of no-shows were analyzed in 2 similar preintervention and postintervention patient cohorts. A mixed effects logistic regression model was used to estimate the association of the odds of being a no-show to the scheduled appointment and the characteristics of the patient and visit. An analysis of costs was performed that included the startup and maintenance costs of the intervention.


RESULTS
We found that a nurse phone call was associated with a 33% reduction in the odds of a no-show visit (odds ratio, 0.67; 95% confidence interval, 0.50-0.91), adjusting for gender, age, partnered status, insurer type, distance from the endoscopy center, and visit type. The recovered reimbursement during the study period was $48,765, with net savings of $16,190 when accounting for the maintenance costs of the intervention; this resulted in a net revenue per annum of $43,173.


CONCLUSIONS
We found that endoscopy practices may increase revenue, improve scheduling efficiency, and maximize resource utilization by hiring a nurse to reduce no-shows. Predictors of no-shows to endoscopy included unpartnered or single patients, commercial or managed care, being scheduled for colonoscopy as opposed to upper endoscopy, and being scheduled for a screening or surveillance colonoscopy.
Division of Gastroenterology, Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA.
Ryan E
RE
Childers
Division of Gastroenterology, Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA.
Amy
A
Laird
Division of Gastroenterology, Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA.
Lisa
L
Newman
Division of Gastroenterology, Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA.
Kian
K
Keyashian
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001071:Appointments and Schedules; D017046:Cost Savings; D003365:Costs and Cost Analysis; D016145:Endoscopy, Digestive System; D005260:Female; D065386:Historically Controlled Study; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D000067455:No-Show Patients / Q000191:economics / Q000706:statistics & numerical data*; D009726:Nurses / Q000191:economics; D010561:Personnel Staffing and Scheduling; D017010:Reminder Systems / Q000191:economics; D012307:Risk Factors; D013689:Telephone