Medical practices are often challenged with how to handle a missed appointment during which follow-up care or treatment was to be provided. It is important that the practice have a procedure to ensure that no-shows and cancellations are communicated to the treating provider and any actions taken are documented in the medical record.
Depending on the patient’s diagnosis and/or reason for the appointment, the treating provider may instruct an assigned staff member to follow-up missed appointments either verbally or by way of a “missed appointment letter.” Generally, the efforts required to contact the patient are commensurate with the patient’s medical condition and potential consequences of missed treatment.
When notifying the treating provider of a missed appointment, staff should include the reason for the visit. Depending on the patient’s diagnosis and/or reason for the appointment, the treating provider may instruct that the patient be contacted and informed of the need for the appointment to be rescheduled and kept. Instructions should include the time frame (e.g., “call patient to reschedule, should be seen within 7-10 days”).
If a patient is at minimal risk (e.g. a well checkup), no action may be required or a single phone call or letter outlining the consequences of failure to receive needed treatment in a timely manner may be sufficient. It may be necessary to warn the patient of possible discharge from the medical practice for repeated missed appointments.
For patients at moderate risk, such as those who need ongoing monitoring or treatment, a more concerted effort may be required. Usually two documented phone calls and a certified letter outlining the consequences of failure to receive needed treatment in a timely manner should be adequate.
If the missed appointment is for the purpose of notifying the patient of abnormal test results requiring further treatment, failure to follow-up on a missed appointment could lead to a delay in diagnosis if the patient is not notified and treatment does not ensue. Generally, the reasonableness of the follow-up effort will depend on the clinical importance of the test results, the severity of the patient’s medical condition and the risk associated with failing to notify the patient of the results.
All efforts to educate the patient and complete the follow-up should always be documented in the medical record. If letters are sent, they should be in clear, reader-friendly language at a fourth grade reading level in order to be understandable and in compliance with Limited-English Proficiency Guidelines. If the letter is returned undeliverable, verify that the address corresponds with the address given by the patient and if the post office provides a new address, resend the letter to the new address and note this in the medical record. If a letter is returned because delivery was refused by the patient, resend the letter to the same address using first class regular mail.
As with all patient communication, staff should document the date and time of the call or place a copy of the missed appointment letter in the patient’s medical record.
If a patient repeatedly does not return to the office, after appropriate contact attempts have been made, the treating provider may take steps to discharge the patient from the medical practice. Please consult an SVMIC claims attorney for assistance by calling 800-342-2239 or 615-377-1999.
Julie Loomis is Assistant Vice President of Risk Education for SVMIC where she develops educational programs and assists policyholders and staff with risk management issues. Ms. Loomis is a member of the Tennessee Bar Association and American Society of Healthcare Risk Managers (ASHRM). She serves on the Risk Management/Patient Safety Committee of the Medical Professional Liability Association. Ms. Loomis is a speaker on risk management and professional liability topics at industry seminars, medical schools and residency programs.
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