Schedulers book a time for a patient, and remind him or her of the appointment by phone, text, email — only to end up with a no-show. This causes lots of lost revenue for hospitals.

“We are actively looking at our no-show rates, and looking for any opportunities to reduce the numbers,” says Robyn Berg, patient access manager at Olmsted Medical Center in Rochester, MN.

Berg says the no-show rate at Olmstead is a steady 6%. Patient access departments are stopping no-shows in a few ways:

Patient access staff find out the reason for no-shows. At Seattle Children’s, patient access leaders audited 589 no-show families. Of this group, 46% said they forgot the appointment, 20% said they had a family emergency or fell ill, and 12% thought they had canceled the visit.

“I would certainly categorize the top reason for no-shows to be lack of good communication that works for our families,” says Megan Brazil, manager of registration.

Patients are offered all types of automated reminders. At Olmsted Medical Center, most patients receive automated reminder calls or texts seven days before the appointment, and again two days prior. Quick reminders (text or email) are sent two hours before the appointment, if patients agree to receive these. Most families at Seattle Children’s receive reminders by phone, text, and MyChart, as well as the rare paper letter that some families request. “Currently, nearly all reminder communication is only in English, but we will expand to include Spanish,” Brazil reports.

Departments have created processes to address frequent no-shows. Everyone forgets an appointment now and then, but some make a habit of it.

If someone is a frequent no-show at Seattle Children’s, the registration system flags it. Schedulers can remind them of expectations to cancel appointments if needed. Some patients are offered only walk-in visits at clinics instead of prescheduled appointments.

Staff make manual phone calls for clinics where no-shows are a particular problem. Some of Olmsted Medical Center’s departments give patients reminder calls the old-fashioned way — by a person. “This is done in areas that have higher no-show rates and the automated reminders don’t seem to be helping,” Berg says. “Certain clinics identified the need for personalized phone call reminders,” Brazil says. “That seemed to help greatly with decreasing no-show rates for these departments.” For example, the ophthalmology clinic schedules around six months in advance. “Those families found a reminder call at two weeks prior was helpful,” Brazil adds.

Staff find a way to provide transportation, if needed. If families need transportation to Seattle Children’s, the hospital’s guest service team works with a local transportation agency to shuttle them to and from the appointment.

Departments make it easy to cancel. “It is unfortunate that even with technology in place to offer our patients the opportunity to cancel, we still struggle with no shows,” Berg laments.

Previously, families at Seattle Children’s had to call to cancel the appointment. The department offered a few other new ways to cancel outside of business hours. Families can call the hospital operator any time, and also can cancel online through MyChart. Most recently, patients are now allowed to cancel via text. “That has made a huge improvement to our no-show rate,” Brazil adds.