The CMPA (Canadian Medical Protective Agency) proposed physicians use a systematic method to track and follow up missed appointments.[1] They provided an example of an easy to implement 'red-green' system for booking appointments.
The Red-Green Appointment System
When an appointment is booked, it is tagged as either red or green.
Red appointments require thorough follow up when missed. Appointments are coded red when something 'critical' will happen in the appointment. For instance, a critical finding must be communicated to the patient, following up on a test result is required, evaluation of a symptom is needed.
When a red appointment is missed, it initiates an escalating sequence of attempts to contact the patient and re-book. If the patient declines, the clinic should try to understand why, and the patient should understand the risks of doing so.
Green appointments do not require as thorough follow up when missed. Perhaps the patient booked the appointment for a sore throat, or it was follow up of a non-critical result. If a green appointment is missed the patient can be contacted and offered to re-book; but if the office cannot easily contact the patient heroic attempts to contact them are not required.
Especially Useful for Group Practices
Color coded appointments are particularly useful for physicians in joint clinics and group practices. In these settings sometimes the physician who triages or schedules an appointment may be different than the physician who sees the patient. In group clinics, when the patient misses an appointment a different physician than that who booked it may be asked about re-scheduling. The physician rescheduling the appointment may be unaware of a 'critical reason' to rebook the appointment that the first doctor was aware of. A color coded system helps ensure everyone in the practice understands the importance and initial intent of the appointment.
Customize it to your Needs
This red-green system can be adapted to your institution. For instance, in Cancer Care there is generally good follow on missed appointments. In this case a red-green system may be more useful to indicate how quickly the appointment needs to rebooked.
Beware
Just as when 90% of scheduled pathology requests are marked 'urgent', scheduling most appointments as red decreases the systems utility as a marker of acuity.
Notes
[1] CMPA 2015 Regional Conference
This the third of three posts based on a presentation I did for noon Oncology Rounds.
1) The Boring Article: Why do Patients Miss Appointments?
2) The Practical Article: 15 Ways to Reduce Missed Appointments.
3) Advise from our Lawyers: implement a color coded system to track missed appointments
SERIES SUMMARY: Patients who miss appointments have worse outcomes. Missed appointments can be predicted and reduced with deliberate interventions.