No-Shows in a Tertiary Care Pediatric Otolaryngology Clinic: Predictors and Impact on Provider Productivity

Objectives: No-show appointments (NS) lead to a mismatch between supply and expected demand, operational inefficiency, decreased access to care, and economic deficit. We evaluated the predictors and impact of NS on provider productivity in a tertiary pediatric otolaryngology clinic. Methods: Patients who had a pediatric otolaryngology clinic appointment were identified. Demographics, type of appointment and clinic visit, provider, insurance, appointment lead time, time of the appointment, caregiver income, distance to the clinic, and season of the year were analyzed. Predictors of NS and loss of providers' work-RVUs and revenue were assessed. NS and non-NS populations were compared using χ² test for categorical variables and Mann–Whitney test for continuous variables. Multivariable analysis was performed with a binary logistics regression model for the prediction of NS. Results: Of 24,593 appointments, 10,392 (42%) were female, (age median = 5 years) and of the 4627 NS 2016 (44%) were female, (age median = 5 years). Logistic regression identified male (OR: 0.093, 95% CI [0.88–0.99], p = 0.04), Black/African American race (OR: 1.97, 95% CI [1.72–2.26], p < 0.001), spring (OR: 0.88, 95% CI [0.80–0.97], p = 0.007), summer (OR: 0.90, 95% CI [0.83–0.99], p = 0.04), clinic focus-general clinic (OR: 1.32, 95% CI [1.20–1.45], p < 0.001), and appointment lead times of 0–7 days (OR: 0.36, 95% CI [0.29–0.46], p < 0.001), 8–14 days (OR: 0.49, 95% CI [0.39–0.63], p < 0.001), 15–30 days (OR: 0.60, 95% CI [0.47–0.76], p < 0.001) were predictive of NS. The estimated loss of work-RVU ranged from 3852 to 14,820, and the estimated loss of revenue ranged from $276,831 to $959,908 per year. Conclusions: No-show appointments led to a substantial loss of provider productivity and revenue. Of the multiple demographic and clinic visit determinants associated with high NS rates, appointment lead time can be tested in future studies of strategies to reduce NS. Level of Evidence: 4.