Assessment
We assessed the effectiveness of this new notification system by monitoring the number of patients who arrived at our clinic by mistake. The 2 clinic secretaries recorded daily on a piece of paper the number of patients who arrived in clinic
Results
During the 14 days prior to the change in notification system, the mean number patients per day who visited the clinic mistakenly was 14.93 (SD = 6.05). After the implementation of the new notification system, the mean number was 9.4 (SD = 3.45; P = 0.005) for the 15-day period after the change was implemented.
The mean number of minutes required to redirect patients was estimated to be 2.28 minutes prior to the change and 2.53 after ( P = 0.507), which equates to an average of 40.64 minutes per day in the initial study period and 22.93 minutes per day in the second study period ( P = 0.05). Assuming a secretary makes on average $22/hour, the Long Beach VA spent an average of $14.90 and $8.41 per day, respectively, redirecting mistaken patients to their correct clinic before and after the new notice system was implemented.
Discussion
The Veterans Health Administration is America’s largest integrated health care system, and is one of the few health systems—and by far the largest—that is virtually paperless [11]. Their medical records are nearly wholly electronic. The VA’s use of electronic health records has significantly enhanced the quality of patient care and improved productivity [12]. Their ongoing mission includes identifying and evaluating strategies that lead to high-quality and cost-effective care for veterans.
Effective appointment notifications have the potential to increase productivity and thus save money. Developing tailored methods of informing patients of the time and location of their clinic appointment improves the accuracy with which patients arrive at large medical campuses, which translates into a more efficient clinic flow. The simpler, abbreviated notification implemented at our VA appears to improve patient understanding of time/location of their clinic appointment, based on the decreased number of patients arriving in error to the ophthalmology clinic. It is unclear which specific aspect of this new mailed notification system is responsible for our results (addition of map, new layout, down-scaling of notification etc). Limitations to our study included reliance on the secretaries’ subjective reporting of time spent redirecting and limiting our data collection to one clinic. In addition, patients arriving at appointments may have received the old notice. Further investigations are underway to study appointment notification improvements across various hospitals and clinics.