Impact of Pre-Procedure Interventions on No-Show Rate in Pediatric Endoscopy

Abstract

Pediatric endoscopy has evolved into an indispensable tool in the diagnosis and management of gastrointestinal diseases in children. However, there is limited literature focusing on quality improvement initiatives in pediatric endoscopy. The primary goal of this project was to reduce the no-show rate in the pediatric endoscopy unit. Also, we aimed to improve patient and family satisfaction with the procedure by identifying opportunities for improvement. A checklist was designed based on the potential causes of no-show. The endoscopy nurse coordinator reviewed the checklist when scheduling the procedure to identify patients at high risk for non-compliance. Once a risk factor was identified, appropriate actions were taken. She also made a pre-procedure phone call as a reminder and to address any of these risks for non-compliance if present. A patient satisfaction survey was used to identify potential areas for improvement. The no-show rate decreased from an average of 7% in the pre-intervention phase to 2% in the post-intervention phase (p = 0.009). 91% of the patients/family recorded an overall satisfaction of 4 or 5 on a scale of 1-5 5 being best). Quality improvement strategies decreased the no-show rate in the pediatric endoscopy unit. A patient satisfaction survey helped in identifying areas for improvement.

Keywords: endoscopy; pediatrics; quality improvement.

Figure 1

Cause and effect (fishbone) diagram of reasons for no-show in pediatric endoscopy.

Figure 2

Statistical process control chart representing no-show rate. Statistical process control chart representing no-show rate in pediatric endoscopy unit from January–November 2013. ucl—upper control limit ($\overline{\mathrm{x}}$ + 3 SD); lcl—lower control limit ($\overline{\mathrm{x}}$ − 3 SD); $\overline{\mathrm{x}}$—mean no-show rate; QI—quality improvement; SD—standard deviation.