Increase in the Patient Show Rate at the HIV Positive Health Care Clinic

The Prioritization Matrix was used to select which QI project would be chosen. Once the team selected attendance rate among HIV Positive Health Care clients as the QI project, the QI lead met with clinic staff to create a flow chart to map out the current process for updating client contact information and to indicate who would contact the client and when. Staff then created a fishbone diagram to solicit ideas as to why clients may not have shown up for their appointment. Using these ideas, she then constructed a Pareto chart to see which reason was most prevalent. The main reason for not showing up was that contact information was not being updated in a timely manner in the client’s paper chart (this clinic does not yet have electronic medical records). It was proposed to have mail bins mounted on the door by the clinicians’ offices and that updated contact information would be attached to the paper chart immediately and updated and verified by the clinician at the time of the appointment. Staff were trained in the new procedure, the mail bins were mounted, and this new process was tested for 8 weeks. After 8 weeks, the no-show rate dropped from 22% to 12%, a decrease of 45%. Based on this successful trend, the process was extended for an additional 4 weeks. However, the no-show rate crept back up to 18%, but it was hypothesized that this was due to the holiday season in December. Snowy weather may have also contributed to this increase.

Data collection continued on contact made with the patient prior to the appointment and his or her show rate for appointments. A data collection sheet was created for front desk staff to track this information, and the QI lead analyzed it weekly.