From the Department of Plastic and Reconstructive Surgery, University of Tennessee Health Science Center College of Medicine, Chattanooga, TN.
Ann Plast Surg. 2024 Sep 1;93(3S Suppl 2):S110-S112. doi: 10.1097/SAP.0000000000003996. Epub 2024 Jun 18.
Absenteeism among clinical patients is a significant source of inefficiency in the modern American health care system. Routine absenteeism limits access to care for indigent patients, thus providing additional strain on the health care system and timely administration of care.This quality improvement project set out to quantify, understand, and potentially reduce patient absenteeism in our weekly plastic and reconstructive surgery resident indigent care clinic. One year prior to our study was retrospectively reviewed to determine a baseline rate of absenteeism (no shows). The daily and monthly no-show percentages were calculated. Then, three consecutive 2-month Plan, Do, Study, Act (PDSA) cycles were performed and data were recorded.The initial year analysis demonstrated an average no-show rate of 25%. The first PDSA cycle attempted to ascertain factors contributing to absenteeism and to get patients rescheduled. The rate of clinical absenteeism was 27% over this period compared with a rate of 18% in the control period. During this period, we discovered a limitation of our institution's electronic medical record (EMR). Rescheduled patients were removed from the original schedule and were not counted as a missed appointment even though the opportunity for care was missed. The second PDSA cycle attempted to collect raw data while trying to understand the EMR error and rescheduling process. During this period, there was a 33% no-show rate compared with 27% in the control period. The third PDSA cycle attempted again to establish factors contributing to clinical absenteeism with a better understanding of the limitations of our EMR. A 33% no-show rate during this cycle was recorded compared with 22% in the control period. After three PDSA cycles were completed, our clinic had an average no-show rate of 31% compared with 25% during the same months in the previous year.This project brought to realization that our data were initially skewed by our ignorance of an EMR flaw that did not track patients who either canceled or rescheduled their appointments. We also learned that there is a certain subset of patients who are not able to be contacted and who do not follow up.
临床患者缺勤是现代美国医疗保健系统效率低下的一个重要原因。常规缺勤限制了贫困患者获得医疗服务的机会，从而给医疗保健系统和及时的医疗服务带来了额外的压力。本质量改进项目旨在量化、理解并可能减少我们每周的整形外科贫困患者诊所的患者缺勤率。在我们的研究之前的一年进行了回顾性审查，以确定缺勤率（未出现）的基线率。计算了每日和每月的未出现百分比。然后，进行了三个连续的 2 个月计划、执行、研究、行动（PDSA）循环，并记录了数据。初始年度分析显示平均缺勤率为 25%。第一个 PDSA 循环试图确定导致缺勤的因素，并让患者重新安排预约。在此期间，临床缺勤率为 27%，而对照期为 18%。在此期间，我们发现我们机构的电子病历（EMR）存在局限性。重新安排的患者从原始时间表中删除，即使错过了就诊机会，也不会被视为错过预约。第二个 PDSA 循环试图在尝试了解 EMR 错误和重新安排流程的同时收集原始数据。在此期间，未出现率为 33%，而对照期为 27%。第三个 PDSA 循环再次尝试了解导致临床缺勤的因素，并更好地了解我们 EMR 的局限性。在此周期中，记录的未出现率为 33%，而对照期为 22%。完成三个 PDSA 循环后，我们的诊所平均未出现率为 31%，而去年同期相同月份的未出现率为 25%。该项目使我们认识到，我们的数据最初受到我们对 EMR 缺陷的无知的影响，该缺陷没有跟踪取消或重新安排预约的患者。我们还了解到，有一定比例的患者无法联系且不跟进。
