HTML Preview Letter To Reschedule Patient Appointment page number 1.
Reducing Risk
A Publication on Healthcare Risk Management from Princeton Insurance
When Patients Don’t Return for Follow-up Care Page 1 of 4 July 2008
Princeton Insurance – Healthcare Risk Services Department: (609) 452-9404
www.PrincetonInsurance.com
E-mail: HealthCareRisk@PrincetonInsurance.com
When Patients Don’t Return for Follow-up Care
Introduction
Communication breakdowns are a major contributing factor in patient safety and malpractice claims. A patient who misses
appointments and suffers an injury as a result may have cause for a lawsuit if he or she has evidence that the physician did not
provide clear information or make reasonable efforts to make sure the patient understood and complied with advice, including
follow-up appointments. While follow-up can be time-consuming, it is well worth the effort to prevent medical errors, unanticipated
outcomes and potential liability.
Handling Missed Appointments
To help prevent missed appointments, practices have developed a telephone confirmation call to remind patients of their
appointments and, when indicated, of the importance of the visit – especially for patients in active treatment. To cut down on the
volume of missed appointments, some studies suggest that the confirmation call should be placed at least two days ahead of the
scheduled appointment.
Standard of care, laws and ethics require that a physician-patient relationship be based on educated, informed/shared decision
making. During office visits, patients should be educated on their disease process, care plan expectation, any perceived issues
the patient has regarding non-adherence to plan of care, and consequences of not continuing with follow-up testing or treatment.
Alternative plans, if appropriate, may be explored, agreed upon, and documented in the medical record. The discussion may be
supplemented by educational material to be reviewed with the patient at the time of visits. The medical record documentation
should reflect what information was shared with the patient, questions asked by the patient and responses given, and that the
patient understood the proposed plan, benefits and the consequences of non-compliance.
Physician practices may consider utilizing a patient agreement or contract which is discussed with and signed by the patient.
During subsequent visits an informed refusal form should be signed if the patient will not comply with the plan. A generic practice
policy statement including patient responsibilities regarding compliance, follow-up and missed appointments may also be
implemented. A signed copy of the policy statement, such as is done with HIPAA privacy statements, may be maintained in the
patient’s record.
If a patient misses a scheduled appointment, every effort should be made to find out why as soon as possible. When there is an
urgent clinical reason, the physician should initiate a phone call to encourage patient follow-up. In those instances where the
physician initiates communication, an explanation recommending the patient’s treatment course, its benefits, and risks of not
adhering to the proposed treatment should be clearly communicated and documented. Office practices should keep clear,
consistent records of missed appointments and follow up.
In non-urgent situations, the physician should instruct staff, and there should be a notation in the medical record, to call the patient
to find out the reason for the missed appointment and to reschedule, being sure to give the time frame. (e.g. “call patient to
reschedule, must be seen within one week”). Staff should document their attempts at contacting the patient, what was said to the
patient and the patient’s response.
While there is no standard number of attempts that should be made, many practices attempt contact three times. A missed
appointment letter should also be sent. If patients repeatedly (e.g. three missed appointments) do not return to the office, a letter
urging patients to follow-up should be sent. The “non-adherence” letter gives such patients one last chance to schedule an
appointment before assuming that the patient has terminated the relationship. If patients still do not return to the office a formal