Date of Award

Fall 2026

Abstract

Abstract

Missed appointments, also known as ‘no-shows,’ disrupt continuity of care in psychiatric outpatient settings, leading to treatment delays, symptom exacerbation, and increased risk of hospitalization. This project was implemented at an outpatient psychiatric clinic where approximately 4 of 14 patients missed scheduled appointments daily, with no systematic follow-up protocol. A quality improvement initiative designed to re-engage patients after missed appointments through follow-up phone calls was implemented using the Plan-Do-Study-Act (PDSA) framework over two cycles from August through September 2026. Patients who missed appointments received a follow-up phone call within 24 hours. Cycle 1 included one call attempt per missed appointment and Cycle 2 added a second call attempt for unanswered calls. Outcomes measured included contact rate, rescheduling rate, and patient-reported barriers to appointment attendance. In Cycle 1, 42 of 58 patients (72%) were reached by phone, and 28 (48%) rescheduled. In Cycle 2, the contact rate improved to 85% (34/40 patients reached) and the rescheduling rate to 60% (24/40 patients rescheduled). Among 76 patients reached across both cycles, the most common barriers reported were forgot appointment (n=25, 33%), insurance or co-pay concerns (n=22, 29%), illness (n=10, 13%), competing responsibilities (n=9, 12%), technology (n=5, 7%), and declining to share (n=5, 7%). The intervention improved rescheduling rates and continuity of care, and the second call attempt further improved outcomes. This replicable intervention is recommended for ongoing use in this clinic and may be applicable to similar settings.

Document Type

Clinical Doctorate

First Advisor

Kerry Nolte

Second Advisor

Norrine McNelley

College or School

CHHS, School of Nursing

Department or Program

Nursing

Degree Name

Doctor of Nursing Practice

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