During fiscal years 2006 and 2007, nearly 1 in 4 Veterans failed to keep their individual nutrition appointments, impeding clinic workflow, productivity, and management of weight and nutrition related health conditions. The purpose of this study was to identify determinants of nutrition appointment attendance in the Veteran population. This study examined the cognitive and structural factors that influence nutrition appointment attendance. Specifically, the study sought to determine: Veteran reported reasons for non-attendance and factors associated with appointment attendance. The research design entailed sequential use of qualitative and quantitative methods. Individual, semi-structured interviews and a mail survey were used to identify factors associated with outpatient nutrition appointment attendance. Seventeen individuals were purposively selected to represent appointment attenders (8 individuals) and non-attenders (9 individuals) in the following age groups: 18-44, 45-64, and 65 and older. Individual interviews were analyzed using constant comparative analysis. For the survey portion of the study, 349 surveys were collected. Descriptive statistics were used to summarize demographic characteristics of the survey sample. Bivariate comparisons of attenders and non-attenders revealed significant relationships between appointment keeping and the following variables: past nutrition appointment attendance, non-VA insurance, health status, income, BMI, forgetting, satisfaction, perceived importance, understanding of scheduling system, RD knowledge, family support, how referred, reminders, input to appointment time, travel, weather, difficulty with transportation, family care, feeling well, cost, parking time, and preferred day. Regression analyses suggest that only perceived family support, past attendance history, health status, and BMI remained correlated with appointment keeping when controlling for other factors. The results of this study will be used to identify ways to reduce no-shows thus increasing clinic efficiency of ambulatory care nutrition programs. The impact of increasing nutrition appointment attendance includes: improved access to nutrition appointments, more efficient use of resources, improved management of nutrition related conditions, and improved patient satisfaction.

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Implementation of Evidenced-Based Practices to Improve Follow-up Care Following Inpatient Mental Health Hospitalizations. Jacqlyne W Bowman, Dr. Judy Rice, Dr. Beth Schreiner, Dr. Ernie Maupin, College of Nursing, East Tennessee State University Persons hospitalized for mental health conditions are frequently lost to follow up after discharge. The aim of this quality improvement project is to increase the rate of attendance at follow up appointments after hospital discharge back to the community. The focus of this project is the development and implementation of a discharge questionnaire for both clients and case management to better understand the needs of the clients during the discharge process. Behavioral health technicians employed by the agency are including the discharge questionnaire in the admission packet for a 12-week trial period. This discharge questionnaire asks clients their preferred location for follow up appointments, if they are active in their care, if transportation is needed for follow up appointments and verifies the patient’s phone number. Clients complete the discharge questionnaire and return it to the behavioral health technicians with their admission packet. The discharge questionnaire is then given to case managers to assess and address concerns outlined on the questionnaire. Data will be gathered over 12-weeks to determine if the rate of non-attendance decreases with the integration of the questionnaire. The project is in the implementation phase. The anticipated outcome is there will be an increase in the rate of attendance at follow-up appointments post discharge with the use of the discharge questionnaire. By utilizing the discharge questionnaire, case managers will be better able to determine barriers that lead to non-attendance to follow up appointments. With the barriers identified and addressed, individuals will be more likely to attend their follow-up appointments and medication compliance and rates of re-hospitalizations will improve.

Lower socioeconomic status, ethnicity, and race are associated with reduced health care use in the United States. Patients who continually miss their appointments suffer significant negative results, including a disruption in continuity of care, complications with their chronic illnesses, and an increase in hospital readmissions. The health belief model was used as the theoretical support for this project that investigated the underlying causes of no-shows at an urban hospital-based outpatient clinic in the United States. It used a quantitative, descriptive design and examined a minority, underserved, and underinsured population that was receiving care at the research site and had a fairly consistent 30% no-show rate. Data was collected by anonymous survey from 151 patients and 22 health care providers and analyzed via means, t tests, and an ANOVA. Female patients were significantly more likely than male patients to approve of the current scheduling system at the site, in which patients simply call the clinic for an appointment (p = 0.040). White (non-Hispanic) patients in general had a statistically lower interest in receiving appointment reminders via text compared to the rest of the population (p=0.024). Patients who were 29 years old and younger were significantly less likely than patients who were 30 years old and over to indicate that they did not show up to appointments due to a lack of insurance (p '? 0.001). This project promoted positive social change by increasing patient, staff, and stakeholder awareness of the reasons patients miss their appointments. The findings of this project can be used to improve appointment scheduling, reduce patient wait times, increase patient satisfaction, and increase cost savings to the clinic.

In the restaurant industry, some patrons do not honor their reservations, especially on holidays. Grounded in postpositivism and system theories, the purpose of this comparative study was to examine the impact of implementing a credit card payment policy for fine dining restaurants reservations and no shows after implementation of a credit card guarantee policy at a high-end hotel located in the southeast United States. Data were collected from archival records provided by the hotel executives. According to the results of a Wilcoxon Signed Rank test, there was a statistically significant decrease in the number of no shows, p < .001, after the implementation of the credit card guarantee policy. In a paired sample t-test, there was a statistically significant decrease in the number of reservations, p < .001, after implementation of the credit card guarantee policy. The implications for positive social change include the potential to increase understanding of payment policies as they relate to the restaurant industry. Service industry managers can benefit from implementing payment policies that can vary from specific dates, seasons, and type of services. Customers will also benefit by being able to make reservations not originally possible due to demand. The current study adds to service industry knowledge, increasing the understanding of payment policies as they relate to restaurant industry. Conducting a similar study in other service industries in the future may lead to a better understanding of the nature of policies and customers' traits and behaviors.

Bakgrund: Uteblivna patientbesök är ett problem som påverkar sjukhusen ekonomi men även patienternas hälsa. No shows är ett uttryck som används för de patienter som utan att meddela ej kommer till bokade besök och denna patientgrupp riskerar i högre grad att insjukna akut samt förvärra sitt sjukdomstillstånd genom att utebli. No shows ger även en stor ekonomisk belastning på sjukvården. Patienter som avbokar eller väljer att ej närvara vid besök, där bland screeningpatienter, löper en högre risk att insjukna akut än de som deltar vid screening. Syfte: Syftet med denna studie var att undersöka faktorer till att patienter uteblir från besök vid röntgenavdelningen. Metod: Denna studie genomfördes som en allmän litteraturöversikt. Artikelsökningen gjordes i databaserna PubMed samt Cinhal och resulterade i 15 artiklar som svarade mot syftet. Resultat: Orsaker till uteblivna besök sammanställdes i sex huvudgrenar; rädsla, praktiska faktorer, ålder, administration, familj och socioekonomisk status. Slutsats: Liknande resultat återfinns i studier vid andra avdelningar och resultatet kunde således generaliseras. Mer forskning behövs om varför dessa huvudgrenar påverkar att patienterna ej kommer på sina besök. Det är av vikt för röntgensjuksköterskan att veta om orsaker till uteblivna besök för att kunna jobba mot en förändring som kan förbättra både sjukhusens ekonomi men även patienthälsan. / Background: Missed appointments is a problem that effects the hospital economics and the patients’ health, No- show patients is a term for patients thats without informing don't come to their booked appointment.This patient’s group has a higher risk of falling ill urgently or aggravate the already existing disease. A patient cost too the health care system is bigger when they miss booked appointments. Patient’s who decline or select not to participate in screening also increases their risk of falling ill. the Screening patients that’s participate decreases risk of sickness or finding it early. Purpose: The purpose of this study was to examine factors to no show patient’s in radiology. Method: A literature review was conducted. Articles searches using databases PubMed and Cinhal resulted in 15 articles that’s matched the purpose of the study. Result: Six different factors/reasons was found, fear, practical factors, aged, administrations, family and social status. Conclusions: Similar results was found in study’s in other departments of the hospital and there for a generalization was possible. More research needs to be done in to how the seven main branches actually effects missed appointments and no show patient’s. It is of importance to the radiology nurse to know the reasons so they can work towards a positive change in both hospital economics and patient’s health.

High patient no-show rates increase health care costs, decrease healthcare access, and reduce the clinical efficiency and productivity of health care facilities. The purpose of this exploratory qualitative single case study was to explore and analyze the managerial intervention strategies healthcare administrators use to reduce patient no-show rates. The targeted research population was active American College of Healthcare Executives (ACHE), Hawaii-Pacific Chapter healthcare administrative members with operational and supervisory experience addressing administrative patient no-show interventions. The conceptual framework was the theory of planned behavior. Semistructured interviews were conducted with 4 healthcare administrators, and appointment cancellation policy documents were reviewed. Interpretations of the data were subjected to member checking to ensure the trustworthiness of the findings. Based on the methodological triangulation of the data collected, 5 common themes emerged after the data analysis: reform appointment cancellation policies, use text message appointment reminders, improve patient accessibility, fill patient no-show slots immediately, and create organizational and administrative efficiencies. Sharing the findings of this study may help healthcare administrators to improve patient health care accessibility, organizational performance and the social well-being of their communities.