Date of Award

Spring 5-23-2020

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Michael Terry, DNP, FNP, PMHNP

Abstract

Abstract

Background: No-shows (NS) are correlated with reduced treatment efficacy, increased financial burden on medical institutions, and early treatment termination for therapy. NS occur for a variety of reasons and appointment compliance within outpatient mental health clinics has a wide variance with clinics reporting no-shows ranging from 15% to 50%. This section of the project is a continuation started by an earlier USD DNP student Fernando Serrano, in which the projects aims were expanded beyond the participation of nurse practitioners only to now include marriage family therapists (MFT), psychologists and medical residents, and to address the NS rates clinic-wide. One year after the initial project was implemented, the year-to-date no-show rates for the entire clinic was 11.40%. For residents it was 12.58%, for nurse practitioners (NP) it was 5.71%, and for MFTs and psychologists it was 12.82%.

Purpose of the Project: Providers and staff will offer patients the ability to sign up for Short Message Services (SMS) appointment reminders. Patients who agree to SMS will receive text messages to their phone with an appointment reminder on the day prior. The goal is to increase SMS use with patients and reduce missed appointments (MA) by 20% clinic-wide and within each group of clinicians.

Framework/EBP Model: The IOWA model was used for this project.

Evidence-Based Intervention: With continual reduced cost and substantial increase in mobile phone technology usage by the general population, SMS has become a new mainstay for direct communication. SMS appointment reminders have been successfully implemented in mental health, radiology, physical therapy, and dentistry with each setting experiencing a significant decrease in no-show rates.

Implementation: After clinic and university IRB approval, SMS teaching material, printouts and reminder notes for providers were prepared. Qualitative statements from the three disciplines about attitude and barriers regarding SMS collected before, during and after the project’s implementation. Pre-data collection included surveying MA rates among all clinic patients for the previous 8 weeks.

15-30-minute teaching sessions took place with psychiatric mental health nurse practitioners (PMHNP), PMHNP students, MFT’s, psychologists, residents, and administration staff. SMS “How to” flyers posted in provider communal areas and in each provider room to instruct and remind providers and staff to offer SMS reminders to patients. Data was collected weekly for 8 weeks examining MAs and provider/staff SMS compliance with offering SMS to patients. Data was continually collected on secured hard drives on excel spreadsheets. Data was generated from reports without any patient identification information.

Evaluation Results: We expected at least 50% of the providers/students/staff would report they are offering SMS to patients at the end of the first 4 week and at least 75% by the end of 8 weeks. We predicted at least 70% SMS signup with patients and a reduction in no-show rates by 20% upon project completion.

Implications for Clinical Practice: We anticipated all providers and staff at the clinic would offer SMS sign up as a part of standard policy and procedure. As SMS sign ups grows, NS will decrease. With a further decrease in clinic wide no-show rates, this program could possibly be rolled out to other UCSD clinic sites.

Conclusions: The brevity, efficiency and cost-effectiveness of SMS allows patients to quickly be reminded of upcoming appointments with the choice to confirm or reschedule as needed. SMS helps increase appointment attendance while reducing provider nonproductive hours from no-shows.

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