IMPROVING GYN APPOINTMENT ATTENDANCE
Elmhurst Hospital Center Immunology Clinic

Project Background

Project Name: Improving GYN appointment attendance

HIV Caseload: 800

Rationale for Selections: A recent review identified that in 1998, only 48% of women scheduled for their annual gynecology (GYN) appointments attended. For this reason this topic was chosen as the improvement area for our HIV QUAL Special Project.

Team Members: The project team was selected to ensure that all aspects of the GYN appointment organization process were represented.

• Linda Lang PhD, Research Coordinator
• Judi Brenner CSW, Assistant Director of Social Work
• Kristine Dorry, ID Clinic Administrator
• Sylvia Jaeger CSW, Title IV Social Worker
• Arline McDonald RN, ID Clinic Nursing Supervisor
• Jagett Sahni RN, Senior Nurse

Success Story

Improvement Goal: To increase the percentage of women who attend their GYN appointment

Methodology: The team identified that the causes of GYN appointment failure included:

• Lack of a reminder process
• Prolonged time lag between booking and appointment date
• Lack of awareness of the importance of a regular GYN exam

A pilot test was conducted from April to June 1999 to measure the effectiveness of a reminder telephone call prior to the GYN appointment. The total number of patients scheduled for the weeks included in the study was 102.

Changes Tested:

1. On the Friday preceding the Monday GYN clinic, a member of the nursing team attempted to telephone all women scheduled for a GYN appointment the following Monday. The purpose of the phone call was to remind each woman of her appointment.
2. The nurse recorded on a special GYN Contact Record Sheet (CRS) the telephone number of each woman, whether or not contact had been made, and any other comments (e.g. if message was left on answering machine or if woman asked to reschedule appointment).
3. On the Monday morning, the GYN nurse marked off all “No Shows” on CRS.
4. Following the GYN clinic, the GYN nurse gave the completed CRS to the Title IV social worker.
5. On receipt of the CRS, the Title IV social worker attempted to contact all the “No Shows” by telephone and interview them to find out the reason why they had not been able to keep their scheduled appointment. She recorded whether contact was made or not and any reasons given for non-attendance.

Results:

• The telephone call was very time consuming and the effectiveness of the phone reminder was clearly undermined by the high prevalence of incorrect phone numbers identified during the study.
• When achieved, direct telephone contact was effective in encouraging the patient to attend or reschedule.
• Messages left on answering machines and with relatives did not have any impact on attendance.

These outcomes led to the following systemic changes:

• Institute regular checks on patient telephone numbers and addresses
• Continue the practice of pre-GYN reminders, but by postcard sent to arrive the week before the scheduled appointment
• Increase the level of health education regarding GYN to women patients

Baseline and Follow-up Data: Although there was no statistical significance, there was a slight improvement in the proportion of women who attended this year compared with the same period last year (T=0.55, P=0.59).

Results:

• Achieved goal of increasing the percentage of eligible patients receiving PCP prophylaxis from 60% in 1998 to 79% in 1999
• Improvements from 79% in 1999 to 100% were observed in June 2000

Summary

Lessons Learned:

• Working as an inter-professional team, where everyone felt ownership of the improvement project and made a contribution, made us more effective and enhanced the improvement project.
• To effect improvement, we need to have clear and achievable goals.
• Data collection and analysis is essential to measure the size of the problem and the effectiveness of any improvement intervention.
• Improvement is an ongoing process.

Next Steps:

• Conduct a follow up survey to find out what is the level and type of GYN health education needed by our patients.
• Find out more about their level of satisfaction with the GYN service provided.
• Measure the effectiveness of improvements implemented as a result of the pilot test.

For more information, please contact:

Judi Brenner CSW
Associate Director of Social Work
brennerj@nychhc.org

Elmhurst Hospital Center Immunology Clinic
70-01 Broadway
New York, NY 11373
(718) 334-5905 (phone)
(718) 334-3741 (fax)