Right-time-And-right-Patient (RAP) program of Li Ka Shing psychiatric out-patient clinic, PWH

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Li Ka Shing Psychiatric outpatient clinic of Prince of Wales Hospital
Introduction :
The new cases non-attendance rate of the LKSPC is noticed to be relatively high, i.e. 13.8%, 14.4% and 14.4% for adult new cases and 13.2%, 10.6% and 11.8% for psychogeriatric new cases in 2015/16, 2016/17 and 2017/18 respectively. The higher new cases non-attendance rate is not unique to psychiatry outpatient clinic, and a study by McGlade also showed similar findings in ear, nose and throat and dermatology clinics.
Objectives :
The RAP program is the pilot one aiming to reduce the observed new cases non-attendance rate in view of the fact that the higher new case non-attendance issue will cause wastage of both clinical and administrative resources, and will further offset our efforts in shortening the new case waiting list in face of the escalating demand.
Methodology :
On top of the conventional measure of making reminder phone calls to patients one week before the scheduled appointments, we will additionally make the second phone calls one day prior to the scheduled appointments again. In case the patients turned down the appointments, these appointments will be refilled by other eligible patients from the waiting list. The concept is borrowed from the Sharing Economy. Thus, the scripts about introduction of the nature and purpose of these second phone calls as reminders and expressing gratitude for sharing of new case appointments to other patients in need are well written for use by two trained nurses, who are assigned to make the second phone calls and to record the non-attendance rates of the booked and advanced cases for both adult and psychogeriatric outpatient population respectively. The pre- and post-program 90th percentile waiting times are also compared to see if the program has any possible impact on the waiting times.
Result & Outcome :
Out of 467 new cases booked, 41 new cases (28 general adults and 13 psychogeriatric) appointments are not attended. The overall non-attendance rate is 8.8%, while the non-attendance rates for general adult and psychogeriatric groups are 8.3% and 9.9% respectively. The outcomes, in percentages, of the all phone reminders made to the attendants and non-attendants respectively are as follows: successful phone talk: 79% vs 4.9%; voice mail: 8.1% vs 1.5%; failure of contact: 4.1% vs 2.4%. The odds ratio for attendance after reminder by either phone talk or voice mail is estimated to be 7.9 (3.4-18.0) P=0.00001, when compared with failure of contact. 25 new case appointments are refilled by eligible patients in the two months period. By the end of the RAP program, the 90th percentile waiting time of general adult is noticed to decrease from 52 weeks to 46 weeks, while the psychogeriatric one remains more or less the same. In sum, the RAP program seems to decrease the new cases non-attendance rate especially among general adult outpatients and to be able to generate additional 150 new case appointments yearly at the expense of minimal extra effort from the nursing and clerical staffs. Reference: McGalde, K.J., Bradley, T., Murhpy, G.J.J., et al (1988) Referrals to hospital by general practitioners: a study of compliance and communication. BMJ, 297, 1246-1248.

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