Utilizing a Nurse Navigator to Decrease No-Show Rates in a Hematology Clinic

November 2019 Vol 10, No 11
Cheryl F. Turner, BSN, RN, OCN
University of Rochester Wilmot Cancer Center, NY

Background: Across diagnoses, patients have varying no-show (NS) rates for provider visits. There are differing reasons patients give for not coming to visits, including forgetting about the appointment and the length of time from referral to appointment. The benign hematology department at Wilmot Cancer Center (WCC) at University of Rochester has a considerable NS rate, with referral date to appointment time averaging 6 weeks. Research also shows that reminder calls from a human are more effective than automated reminders. At WCC, patients are set up to receive automated telephone and patient portal “MyChart” (MC) reminders. WCC initiated a hematology nurse navigator (NN) role in January 2019, covering new patients referred to benign hematology and multiple myeloma. One goal of the NN is to maximize new patient visits (NPV) that are available.

Objective: To determine if benign hematology patients with a high NS rate (>10%) who are contacted by a NN prior to a scheduled NPV are more likely to attend visits than before the NN position was implemented.

Methods: NS data was retrospectively obtained for June 2018 through March 21, 2019 from EPIC eRecord system for the benign hematology department at WCC. From March 21, 2019, going forward patients with >10% NS rates were prospectively identified from EPIC eRecord system. Starting March 21, 2019, the NN contacted all identified patients either by phone and/or message through MC within 1 week prior to NPV. NS rates of all NPV are tracked for benign providers after initiation of intervention to determine if NS rates improved.

Results: The NS rate (NS patients/all NPV as %) for the 10 months prior to implementing the phone call intervention was 11.88% to 18.42%, average 15.38%. The NS rates for the 5 months after implementation were 5.55% to 12.21%, average 9.04%. The decrease in NS rates is statistically significant with f ratio of 24.27266 and a P <.01.

Conclusion: Decreasing the NS rates continues to be an ongoing effort at WCC. The current improvement is appreciated but could be expanded. Other NS predictive measures could be utilized to address barriers to maximize NPV as well as follow-up visits. It would also be more effective financially to utilize a layperson such as a clinical secretary to make the phone calls instead of using nursing time. It is also preferable to call all patients with an NPV, not just those with high NS rates. Future research might be conducted regarding diagnosis specific NS rates, for instance sickle cell, with more of an effort made to combine clinic visits across services to increase the likelihood that patients will attend visits.

Sources

  1. Allemang B, Allan K, Johnson C, et al. Impact of a transition program with navigator on loss to follow-up, medication adherence, and appointment attendance in hemoglobinopathies. Pediatr Blood Cancer. 2019;66:e27781-e27789.
  2. Andreae M, Nair S, Gabry J, et al. A pragmatic trial to improve adherence with scheduled appointments in an inner-city pain clinic by human phone calls in the patient’s preferred language. J Clin Anesth. 2917;42:77-83.
  3. Goffman R, Harris S, May J, et al. Modeling patient no-show history and predicting future outpatient appointment behavior in the Veterans Health Administration. Military Med. 2017;182:1708-1714.
  4. Kumthekar A, Johnson B. Improvement of appointment compliance in an underserved lupus clinic. BMC Health Serv Res. 2018;18:610.
  5. Pecac-Lima S, Cronin P, Ryan D, et al. Patient navigation based on predictive modeling decreases no-show rates in cancer care. Cancer. 2015;121:1662-1670.
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