Mind the Gap poster
To close the loop on and share learnings from incidents, staff at Princess Margaret Cancer Centre launched the Mind the Gap Quality campaign to raise awareness of the importance of consistently following up with patients who miss appointments. (Photo: PM Quality Committee)

With about 200,000 patient visits annually, ambulatory clinics at Princess Margaret Cancer Centre are always busy places.

But just as it's important to care for patients during their visit, it's also necessary to follow up with those who miss appointments.

A quality initiative called Mind the Gap is following up with patients who miss appointments within 24 hours, or during the same clinic day if possible, to find out why.

The follow-up process enables better and safer monitoring of patients – from those needing time sensitive treatment, to those coming for a yearly follow up.

"Ambulatory Care settings are really complex," says Sabrina Bennett, ambulatory manager at the Princess Margaret. "We have huge volumes and many clinical and clerical staff."

Standardization has been the key to improving patient care and communication among staff. Mind the Gap is a result of incident analysis by the Princess Margaret Quality Committee, which works to perform incident and trend analysis to improve processes and safety across the cancer centre.

Using the Quality Committee's findings, the Ambulatory Quality and Operations Committee at the Princess Margaret assessed the process for dealing with no shows and recognized that each clinic had a different method for handling missed appointments.

"So we put in place a standardized way to clearly document in the clinical record that a no-show patient had been followed up with," Sabrina says. "We made sure all of the managers, physicians, and site leaders were at the table so we could draft a process that clearly identified the workflow."

The impact has been dramatic.  Since implementing Mind the Gap in March of last year, 96 per cent of patients are receiving follow-up, compared to 70 per cent when each clinic had a different follow up process.

How it works

When a patient fails to show up at a scheduled appointment, a Patient Flow Coordinator (PFC) notifies the clinical team.

A clinician in the clinic will then assess and make a decision on the next course of action based on whether the patient is undergoing treatment, being monitored as a long-term follow up, or is a new patient or internal referral.

For patients undergoing treatment, a nurse will phone within 24 hours to determine why the patient missed their appointment. The PFC will then rebook the appointment.

"Having a registered nurse check in with no-show patients who are actively on treatment is really beneficial," Sabrina says. "If the patient is at home and unwell and that's why they didn't come in, the nurse is able to give them advice and address any health issues that may have impacted their ability to come to clinic."

For patients on long-term follow-up, the physician will determine if the appointment needs to be rescheduled. If not, the patient's family doctor will be notified and the patient can be discharged from the cancer centre.

The ambulatory team continues to audit the standardized process to evaluate other opportunities for improvement.

Partnering with patients

"We now have a clear standard for all clinics and a way that it's documented," says Sabrina.

"It's also about looking at things from a patient's perspective. You always hope there's never a negative impact to a patient because of a process we don't do correctly, but really thinking about the patient experience and what could happen helped us move this forward."​

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