A case study comparing patient no shows between appointments booked online versus other booking methods

A patient no-show means that a patient has failed to come into the clinic for a scheduled appointment without providing any notification. Recent studies in Canada have reported no-show rates of up to 25%.¹ Missed appointments increase healthcare burden by decreasing immediate availability to clinical appointments and increasing overall wait times, which is especially critical during a time when there is increased pressure on the Ontario healthcare system.

Impact of No shows

There are many reasons why patients miss their appointments. Forgetting and miscommunication are the two most common reasons, while access to transportation and other commitments also contribute to no-show appointments.^1,3 Studies have found that shortening the wait times between the schedule and the actual appointment will help reduce no-shows because patients are sensitive to time delays.² Adding automated reminders can also help to adjust patient behaviours. Previous research has found that telephone reminders can reduce the no-show rates from 20.99% to 7.07%.⁴

Also, empowering patients to self-scheduling is another strategy to reduce the no-show rate. A survey study shows a 53% relative reduction in no-show rates for patients using a patient portal with a scheduling function compared to non–patient portal users.⁵

An analysis of 33 sites that implemented OAB in the Ontario Health West region was conducted to evaluate the impact of OAB on patient no shows. There was a statistically significant difference in patients no-shows with OAB (11,200 appointments included in analysis) versus patient no-shows using other booking methods such as phone appointments (351,620 appointments included in analysis) p<.001. Appointments booked through OAB had a lower proportion of patient no-shows. The below are detailed results from 2 primary care clinics with a higher number of OAB appointments (Figure 1 and 2) among the sites that were analyzed:

Table 1 below estimates the number of no-shows avoided and potential billing loss averted in Clinic A and B. The calculations take into account OAB conversion rates of 50% and 90% for an average of 360 appointments per month for a clinician, with an average billing cost of $40 per appointment.

Based on the pressures the current healthcare system is experiencing, being able to ensure that as many patients receive the necessary care in primary care contributes to alleviating health system wide pressures. Averting no-shows also ensures continuity of revenues for clinicians.

1. Glauser W. (2020). When patients miss appointments, everyone pays. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 192(6), E149–E150.
2. Marbouh, D., Khaleel, I., Al Shanqiti, K., Al Tamimi, M., Simsekler, M., Ellahham, S., Alibazoglu, D., & Alibazoglu, H. (2020). Evaluating the Impact of Patient No-Shows on Service Quality. Risk management and healthcare policy, 13, 509–517.
3. Kaplan-Lewis, E., & Percac-Lima, S. (2013). No-show to primary care appointments: why patients do not come. Journal of primary care & community health, 4(4), 251–255.
4. Drabkin, M. J., Lobel, S., Kanth, N., Martynov, A., Hunt, H. W., 3rd, Guerrero, D., Fogel, J., Grechanik, A., Mancuso, C. D., & Lev, S. (2019). Telephone reminders reduce no-shows: A quality initiative at a breast imaging center. Clinical imaging, 54, 108–111.
5. Graham T, Ali S, Avdagovska M, Ballermann M (2020). Effects of a Web-Based Patient Portal on Patient Satisfaction and Missed Appointment Rates: Survey Study. J Med Internet Res;22(5)