Reducing Missed Outpatient Appointments in Pediatric Urology: A Pre-Post Analysis of an Automated Text Reminder Intervention

Abstract

Introduction: Missed outpatient appointments, or no-shows, decrease clinic efficiency and are a major challenge in delivering high-quality, cost-effective care. Given the ubiquity of smartphones, automated text reminders are an attractive tool to promote appointment adherence. Thus, our study aims to describe the prevalence and predictors of pediatric urology clinic appointment no-shows and the effectiveness of an automated text reminder system.

Methods: We surveyed all in-person and telehealth pediatric urology clinic appointments within our institution's health system from January to December 2023. Ethnicity, native language, need for interpreter, clinic site, visit type, appointment time, and insurance type were measured. The primary outcome was appointment no-show rate. Secondary outcomes were appointment cancellation and rescheduling rates. Odds for no-show, cancellation, and rescheduling were compared between the preintervention and postintervention groups. A univariate and multinomial logistic regression model was used with attended visits as the reference for the outcome.

Results: A total of 15,315 outpatient urology clinic appointments were scheduled; 60.0% attended, 24.1% rescheduled, 9.4% cancelled, and 6.5% missed/no-show. Implementation of text reminders was associated with more visit cancellations (odds ratio [OR] 1.20 [1.01-1.42]), but fewer rescheduled visits (OR 0.78 [0.70-0.86]) and no-shows (OR 0.72 [0.60-0.85]). Spanish language, follow-up visits, and nurse visits were less likely to no-show (OR 0.66 [0.54-0.79], 0.80 [0.68-0.93], and 0.15 [0.06-0.37], respectively). Patients with public-payer insurance or appointments before 10:00 am had a higher odds of no-show (OR 3.38 [1.95-5.86] and 1.25 [1.04-1.51], respectively).

Conclusions: An automated text reminder system is effective in reducing no-show rates for pediatric urology clinic appointments in an academic tertiary care setting.

Keywords: clinic scheduling; no-show; pediatric urology; quality improvement.