I am an eye specialist and own two practices. I want to make this a prosperous business. Some of my patients who have booked appointments fail to keep them. This means an empty consulting chair and loss of potential dispensing income. What can I do to prevent this from happening?

This is a problem faced by eye specialists all over the world, in primary care practices, secondary care hospitals, and tertiary care specialist centres. I’ve come across it in my practice where we referred to this as ‘a no-show’. Other terms are failed to attend (FTA), did not attend (DNA,) and did not show (DNS). In the government hospitals, I have worked in practices where patients who DNA’d were automatically discharged. It took around four months to get back into the system and this delay in receiving treatment often resulted in patients always attending future appointments.

I have worked in practices where in order to avoid no-shows every single patient was phoned the day before their appointment to be reminded of their appointment and to check that they were still attending. Those patients who said they couldn’t attend could have their appointment slots filled with patients calling for an appointment later that day or early on the day of the cancelled appointment.

It took a lot of time and cost to phone 20-40 patients every day.

Research has shown that the strongest predictor of a patient no-showing their appointment is a history of missing appointments. Those missed appointments will probably make up about 10% of your patient base.

Here are some other tips gleaned from the research:

• Don’t make a blanket policy when it’s a small segment of patients who are missing appointments.
• Restricting appointment scheduling to same-day or only one-day-ahead for chronic no-showers.
• If a particular patient no-shows frequently, double-book the time slot in anticipation of them not coming. That way you won’t miss out on income by having an empty spot in your schedule.

I think it’s much better to target those patients who have failed to show up for an appointment in the past. Once a person has failed to show this should be prominently marked on the patient’s electronic or paper clinical records. Then when the patient books another appointment they can be identified as a patient who has DNA’d and then be phoned the day before the day of the appointment. This takes time and money but not as much as phoning every patient with an appointment. Remind the patient of the importance of an eye examination (eye health and general health) and get the patient to verbally agree to attend the forthcoming appointment. It is more difficult for them to fail to show if they have spoken to a person and verbally confirmed their attendance.

A person who regularly fails to attend can be asked to pay in advance or not be given any future appointments.