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Rolling with first PDSA @ St. Christopher’s March 30, 2006

Posted by tking in General.

We are up and rolling with first PDSA  cycle on AIM to decrease assessment no shows for our Evening O/P Clinic.

March must be blessed because there has been no madness.  No show rate has been 0% against a baseline of 40%.  First PDSA has been successful so will continue through next cycle.



1. Elizabeth Strauss - April 3, 2006

What was the change that worked so well?

2. Thomas King - April 4, 2006

We had realized that we were not calling back when someone failed to show up for an assessment. The simple change was to call back withing 24 hours to try and reschedule an appointment for assessment. The change was geared toward our Evening Outpatient Clinic, as entry into our residential unit is quite different. We’re not talking huge numbers here but we were concerned that our no-show rate for assessments was running about 40%. We started the PDSA in March and all assessments scheduled were completed. It’s hard to tell if the change really had anything to do with this result since no assessment had to be rescheduled but we will continue though April as good practice.

3. Ally Evans (NIATx) - April 6, 2006

Thomas – do you use any methods for reminding folks of the date and time of their assessment appointment?

What methods have others been using to decrease no-shows??

4. Stacy Knowles - April 7, 2006

We attempted the reminder calls in our out-patient clinic but did not see any significant change in no-show rates. This was likely do to the clients we serve – no phones, shelters etc.
Stacy Knowles

5. Nadia Guevara - April 7, 2006

Thomas – how does the process for scheduling appointments work at your agency? Is it centralized or counselors schedule thier own appointments? Who makes the phone calls?

6. Thomas King - April 7, 2006

In the Admissions Dept. we have two pre-admission clerks who do make reminder calls the day before the appointment for the assessment for the Evening Outpatient Clinic. To schedule the appointments they check the counselors scheduler in Outlook and find a time that is open. For the most part this works but occassionally people forget to update their scheduler. Luckily we usually have some back-ups who could do the assessment if necessary. For the residential program, the pre-admission clerks get the necessary information, including the medical records and then this is checked by the admissions nurse to see if the person is appropriate for admission. Once this is completed then it’s just a matter of the scheduling the admission for the next open bed date. Once the person is admitted, their resources are checked by our Billing Dept. and once cleared for treatment the assessments are scheduled from a rotating list each day.

7. Nadia Guevara - April 18, 2006

We do something similar at our outpatient program in which we have assigned one person to coordinate the appointments for all assessments. We have not able to have this calendar available for everyone so we rely on the scheduler to fax everyone’s scheduled by firday for the following week. You said that you use outlook, I will check with our IT person to see if he can come up with a system that we can all use to see everyone’s schedule. Do you all are able to see everyone’s schedule? Do you think that this would be helpful, or it does not matter.

8. Thomas King - April 18, 2006

The Outlook calandar is a handy tool because everyone is able to see if a person is available at a particular time. This works great for scheduling the assessments but also for scheduling a team meeting.
If you have someone faxing everybody’s schedule by Friday each week, it may be working to some extent but seems like it has created a middle step that is time consuming. With Outlook you could check team member’s calandar to see if they would be available (within minutes) and then e-mail proposed meeting to which team members will confirm if they will be attending.

9. Thomas King - May 1, 2006

We continued with PDSA throughout April on this initiative and again the no-show rate was 0%. There were only a few assessments scheduled in this period but everyone scheduled showed-up. We decided to sustain this change as good pratcice and will look to change our initiative for the next cycle. We are concerned that a number of clients who have been admitted to our shelter (housing)
have been leaving prior to being admitted to tx. We have clients who are assigned as Admissions Clerks and we will appoint them as “encouragement leaders”. This way if a new client is thinking about leaving he would have someone to speak with if there were no staff members available.

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