Description 

• This policy defines what constitutes a late, no-show, or patient cancellation, articulates the responsibilities of the patient, scheduler, and procedure area regarding no-show, late, and canceled appointments, as well as provides an overview of the appropriate contact with patients after a no-show or chronic late arrival/cancellation of an appointment as necessary to ensure patient safety.

Rationale 

• When a patient does not arrive for a procedure visit, this may pose a risk to the individual patient or other patients from delayed care. The patient must understand the risk of not obtaining care and delaying procedures for others. 

• When a patient fails to notify a procedure area in advance that they will not be arriving for a scheduled procedure, this interferes with the hospital’s ability to offer this procedure time to another patient. When a patient repeatedly cancels or arrives late for a procedure, workflow is disrupted, which may negatively impact other patients, providers, and staff.

Definitions 

• Late Patient: The patient presents at registration in 30 minutes after the procedure arrival time

• No-Show Patient: The patient does not attend their scheduled procedure 

• Patient Cancellation: The patient notifies a member of the department scheduling staff more than 24 hours before their scheduled appointment to cancel the appointment via MyChart note, phone call, in-person, voicemail, or vendor appointment reminder responses 

• Same-Day Patient Cancellation: The patient notifies a member of the department scheduling staff less than 24 hours before their scheduled appointment to cancel the appointment via MyChart note, phone call, in-person, voicemail, or vendor appointment reminder responses 

• Provider Cancellation: The provider requests to cancel the patient's appointment 

Policy/Procedure 

• A. Responsibilities 

  • It is the responsibility of the patient to: 

    • Arrive for their scheduled procedure at the instructed arrival time to ensure the timely operation of the procedure and a positive experience for themselves and other patients. Late patients are not guaranteed to have their procedure performed and may need to be rescheduled. 

    • Notify the scheduling department as early as possible of a cancellation so they can be rescheduled and the slot can be available to other patients 

  • It is the responsibility of the scheduling and front desk staff to: 

    • Inform patients of the No Show/Late/Cancellation Policy at the time of scheduling 

    • Reiterate the No Show/Late/Cancellation Policy to the patient during scheduling, via MyChart notification if the patient is enrolled in MyChart prior to the appointment date; and via text notification and/or Mychart notification after the patient's appointment has been marked as a no show within the EMR.  

    • Notify the procedure area immediately of a same-day cancellation by the patient so the slot can be filled if there is opportunity to do so 

    • Document no shows, late arrivals, and cancellations appropriately in Epic™ If the patient does not present, the visit should be statused as a no show 

      1. If the patient cancels within 24 hours, the visit should be canceled with the most appropriate cancellation reason available and rescheduled 

      2. If the patient is late to the appointment and can be fit in on the same day, the original visit should be left as is and the patient checked in at the later time 

      3. If the patient is late to the appointment and cannot be fit in on the same day, the visit should be canceled with the most appropriate cancellation reason available and rescheduled 

    • Attempt to reschedule or "fit" late patients into the procedure schedule with approval from the on-call attending. 

    • Notify the scheduling department of provider cancellations pursuant of the Provider Bump Policy 

    • Provide rescheduling options for the scheduling staff to reschedule bumped patients 

    • Notify the referring provider and/or Primary Care Provider (PCP) when the patient did not present for the procedure and was unable to be rescheduled (either due to patient refusal or unable to contact) 

      1. For UNCHCS providers on Epic™ and UNC CareLink, an automatic In Basket message will be sent to the referring provider and PCP 

      2. For external providers, clinic staff should place a phone call, fax, or email to the referring provider and PCP to notify each of the patient's no show. Please note that faxes and emails can be automated if the external provider's contact information is updated in the Provider master file (SER) in Epic™. 

  • It is the responsibility of the Department Manager to: 

    • Ensure the procedures for no shows, late arrivals who cannot be accommodated same day, and late cancellations are appropriately followed (see section IV.b. – Clinic Termination Procedure) 

    • Ensure the procedures for rescheduling no shows, late arrivals who cannot be accommodated same day, and all cancellations are appropriately followed (see section IV.c. – Reschedule Policy) 

    • Collaborate with physicians to assess the clinical acuity of patients who no show or cancel to identify if they should be rescheduled earlier than the parameters outlined in the Reschedule Policy (see section IV.c. – Reschedule Policy) 

    • Collaborate with physicians and the Medical Director as needed to communicate with patients regarding dismissal 

• B. Clinic Termination Procedure 

  • Patients who no show, arrive late (and cannot be accommodated on the same day), or cancel within 24 hours of the scheduled appointment three times within 12 months, can be dismissed from the procedure area’s care and will have their no show frequency displayed in the DNKA (did not keep appointment) graph on the patient's appointment desk. Patient dismissals for repeat offenders gives providers the opportunity to improve access for other patients. All patient dismissals are made at the provider's or division chief’s discretion. 

  • The following actions will be taken for patients who do not present for an appointment: 

    • First Occurrence: Automated vendor text or call placed to no show patients four business days after the missed appointment to notify that the appointment was missed. MyChart letter sent to patients explaining the No Show/Late/Cancellation Policy. Notation is made on the patient's account.

    • Second Occurrence: Automated vendor text or call placed to no show patients four business days after the missed appointment to notify that the appointment was missed. MyChart letter sent to patients explaining the No Show/Late/Cancellation Policy. Notation is made on the patient's account. The patient's no show frequency is displayed in the patient's DNKA (did not keep appointment) graph on the appointment desk. 

    • Third Occurrence: Automated vendor text or call placed to no show patients four business days after the missed appointment to notify that the appointment was missed. MyChart letter sent to patients explaining the No Show/Late/Cancellation Policy. At the provider's or division chief’s discretion, the patient is sent a written notice informing them of termination from the procedure area. The letter will detail the reason for termination, effective date, interim and continued care provisions, and patient responsibility henceforth. Procedure areas that elect to dismiss patients should reference and adhere to the Guidelines for Patient Dismissal available from your entity leadership/Legal team. 

• C. Re-Schedule Policy 

  • The following steps should be taken to reschedule canceled and no-show patients who are not in excess of three late cancellations, arrivals, and/or no-shows within a 12-month period. Department Managers or their designee(s) are responsible for contacting no-show or canceled patients:

    • Patients who cancel their appointment via phone call or in person should be asked during the same phone call/encounter if they would like to be rescheduled, regardless of how far in advance they notify the clinic of the cancellation. 

    • Patients who cancel via MyChart, vendor reminder calls, or voicemail should be contacted within two business days of their cancellation to provide the option to reschedule unless clinical acuity requires an earlier call. Staff can utilize the voicemail box, the daily Follow-Up Report in Epic™, and MyChart notifications to determine patients who should be contacted. Staff should attempt to contact the patient three times, one call per business day following the first call, before considering their follow-up to be due diligence complete. The procedure area should establish definitions for which clinical situations warrant an earlier phone call.

    • Patients who do not present for their scheduled appointment should be contacted within two business days to notify of the need to reschedule. The automated next-day vendor call to no-shows is sufficient for this notification unless clinical acuity requires a manual call. Procedure areas may also elect to place manual calls to no-shows, though this is not required. 

      1. The procedure area should establish definitions for which clinical situations warrant an earlier phone call.

Approval Process 

• • The following forums will be utilized for decision-making, advisory, and information sharing purposes related to this policy: 

    • Decision-Making Forums and Approval Process: Entity Leadership Dyad + CASI Dyad, Physician Practice Management Committee, CEO Round Table (if appropriate) 

    • Advisory Forums: Medical Directors, Clinical Chairs, Entity specific forums (Ambulatory Governance-UNCMC, Physician Oversight-Rex, PN Operations-UNCPN, PN Executive-Caldwell, others as identified) 

    • Informational Forums: Leadership Groups at each entity, ACA/VP Meetings (at each entity), Physician Networks, ISD, Network Development, Public Affairs & Marketing, others as identified 

Enforcement/Exceptions 

• A. Enforcement 

  • Regarding patient cancellations, late arrivals, and no show patients, it is the responsibility of the procedure staff to identify and escalate policy offenders to the Procedure Area Manager. It is the responsibility of the Procedure Area Manager to uphold these policies, assess the patient's clinical acuity with the provider, and seek the Medical Director's approval for any patients who could be dismissed. Providers will ultimately make final decisions regarding patient dismissal; Procedure Area Managers will be responsible for informing patients of dismissal, with assistance from the dismissing provider if needed. 

• B. Exceptions 

  • Events that are outside of the patient's control including, but not limited to: hospital admission, death in the family, accident, illness, or other catastrophic events 

  • In the event of a same day appointment delay by 30 minutes or more, patients should not be penalized for a late arrival. 

    David Mauro MD