The walk-in clinic model improves access to psychiatry in primary care.
Missed appointments decrease clinic capacity and negatively affect health outcomes. The objective of this study was to increase the proportion of filled initial psychiatry appointments in an urban, hospital-based primary care practice.



Patients were identified as having a high or low risk of missing their initial psychiatry appointments based on prior missed medical appointments. High-risk patients were referred to a walk-in clinic instead of a scheduled appointment. The primary outcome was ratio of filled appointments to booked appointments. We used a statistical process control chart (p chart) to measure improvement. Secondary outcomes were percentages of patients from historically underserved groups who received an initial psychiatry evaluation before and after the intervention.



The average ratio of filled to booked initial appointments increased from 59% to 77% after the intervention, and the p chart confirmed that this change represented special cause variation. No statistically significant demographic differences between the patients who received psychiatric evaluations before and after the intervention were found.



Missed initial psychiatry appointments can be accurately predicted by prior missed medical appointments. A referral-based walk-in clinic is feasible and does not reduce access to care for historically underserved patient groups.
Harvard Medical School, United States; Department of Psychiatry, Brigham and Women's Hospital, United States. Electronic address: dskroll@partners.org.
David S
DS
Kroll
Social Work and Clinical Services, Brigham and Women's Hospital, United States.
Annie
A
Chakravartti
Social Work and Clinical Services, Brigham and Women's Hospital, United States.
Kate
K
Gasparrini
Social Work and Clinical Services, Brigham and Women's Hospital, United States.
Carol
C
Latham
Harvard Medical School, United States; Department of Psychiatry, Brigham and Women's Hospital, United States; Center for Metabolic and Bariatric Surgery, Brigham and Women's Hospital, United States.
Paul
P
Davidson
Social Work and Clinical Services, Brigham and Women's Hospital, United States.
Martha
M
Byron-Burke
Harvard Medical School, United States; Department of Psychiatry, Brigham and Women's Hospital, United States.
David F
DF
Gitlin
D000328:Adult; D001071:Appointments and Schedules; D005260:Female; D006297:Health Services Accessibility / Q000639:trends*; D006801:Humans; D008297:Male; D010044:Outpatient Clinics, Hospital / Q000639:trends*; D010349:Patient Compliance / Q000523:psychology*; D011320:Primary Health Care / Q000379:methods / Q000639:trends*; D011570:Psychiatry / Q000379:methods / Q000639:trends*; D012017:Referral and Consultation / Q000639:trends*
Missed appointments; Primary care; Quality improvement