Introduction: Time from referral to appointment for kidney transplant evaluation is an important metric. Demands of dialysis schedules and transportation logistics typically lead to high no-show rates, cancelled appointments and long appointment waiting times. We sought to meaningfully decrease our time to kidney transplant evaluation.

Methods: Sequential interventions are described: Intervention 1: We scheduled all Medicare patients with next available appointments immediately after receiving referrals. Commercial patients were scheduled 2 weeks after receiving referrals to allow for financial authorizations. Simultaneously, we increased the number of available appointments on Tuesdays and Thursdays due to the large volume of candidates who dialyze M/W/F. Intervention 2: We noted that no-show rates were a barrier to available evaluations and began a pilot of reminder letters and phone calls. Intervention 3: Upon learning that patients wanted to cancel or postpone their evaluation, we backfilled their appointments with candidates who desired an earlier appointment.

Results: Baseline time to evaluation was 55 days. After intervention 1 (more appointments, rapid scheduling), referral to evaluation time increased slightly to 58 days. Following intervention 2 (reminder letters, phone calls), the referral to evaluation time decreased to 40 days with a concomitant drop in No-show rate from 22% to 16%. While these interventions were helpful, intervention 3, back-filling cancelled appointments, showed the most dramatic effect on time to evaluation, with a decrease to 19 days.

Conclusions: Referral to evaluation time is a critical metric for candidates and transplant programs. Increasing clinic slots and reminder phone calls had a modest effect on decreasing time to evaluation. However, no-shows for evaluations decrease staff productivity and cause delays for motivated candidates. The interventions above markedly decreased time to evaluation by scheduling motivated candidates through backfilled appointments. In effect, our improvement in time to evaluation was a conversion of "no-shows" into motivated candidates.

CITATION INFORMATION: Gibney E., Payne K., Fowler C. Reducing No-Show Rate and Filling Cancelled Appointments: Multi-Faceted Interventions Markedly Reduced Time to Kidney Transplant Evaluation Am J Transplant. 2017;17 (suppl 3).

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