Abstract
Background
The Canadian Association of Gastroenterology reports that wait times to see a gastroenterologist are too long, even for urgent problems. Cancellations and no-shows compound this problem and lead to poor services utilization. A weekly urgent GI clinic started at St Joseph’s Healthcare Hamilton in March 2014 to improve timely access for patients. The clinic accepted referrals from the emergency room (ER) and urgent care with a capacity of 6 patients per week booked within 3 weeks of referral. The cancellation and absence rate from the clinic was 25% in the first 6 months despite patients receiving mail and phone reminder. Studies in no-show predictors focus on primary care, pediatric population and routine outpatient appointments. Published studies on absence rate in urgent clinic settings are very limited.
Aims
The present study explores patient factors for the high absence rate at our urgent GI clinic.
Methods
Retrospective review of patients booked to the urgent GI clinic between March and September 2014 that were absent at their appointment. The patient demographics, reasons for referrals, duration of symptoms were reviewed from the chart. The patients were contacted to explain why they missed their appointment and were offered to be rebooked.
Results
Between March and October 2014, 37 patients (25%) were absent for their appointment to the urgent GI clinic. The average age of patients was 51 years, and 43% were females. The mean duration of symptoms was 28.2 weeks, but 56% of patients had more acute symptoms for 1 week or less when presenting to ER or urgent care. The reasons for referrals included lower GI bleeding (24%), upper GI bleeding (22%), abdominal pain (16%), dysphagia (8%), anemia (5%) and inflammatory bowel disease (5%). Several attempts were made to contact patients, and 22/37 (59%) were reached. Of the 22 patients, 10 elected to cancel without rebooking, 3 were seen as inpatients, and 3 were seen by another outpatient gastroenterologist. Only 6/22 (27%) were rebooked to another urgent clinic appointment.
Conclusions
The urgent GI clinic is a useful means for seeing patients with subacute GI illness but has an unacceptably high rate of missed appointments. Of the patients we contacted, only 27% were rebooked back to the urgent clinic. Almost half elected not to rebook suggesting that an urgent referral may not have been appropriate. On the other hand, 3 patients were admitted, suggesting that outpatient management may not have been suitable either, and 3 patients decided to follow up with their established gastroenterologist. The urgent GI clinic now screens all referrals for appropriateness, and does not see patients seen within the past year by another gastroenterologist. Follow-up data will hopefully demonstrate reduction in absence rate with this new strategy.
Funding Agencies
None