Date of Award

Summer 2026

Document Type

Project – Full Written

Degree Name

Doctor of Nursing Practice (DNP)

Committee Chair

Tina Lewis

Abstract

Background: Missed patient appointments cost the healthcare industry billions annually, reducing provider accessibility and practice revenue. At a rural family medicine office in western Lincoln County, North Carolina, new patient no-show rates exceeded 10%, surpassing the healthcare system’s goal of 5% or less. Automated appointment reminders via text, phone, and email were already in place, but did not adequately address the problem. New patient appointments occupy a 40-minute time slot, twice that of established patients, increasing the impact of each missed appointment.

Purpose: The purpose of this quality improvement project was to determine whether personal phone call reminders made with 24-48 business hours of a scheduled new patient appointment would reduce the no-show rate to less than 5% when compared to automated reminders.

Methods: Guided by Dorothea Orem’s Self-Care Deficit Theory, a prospective quality improvement design was implemented over a 30-day period in December 2025. This was done at the rural family medicine office and included two providers and their assistants. All new patients scheduled during the implementation period by these providers were included; previously established inappropriately scheduled patients were excluded from the study. Provider assistants utilized a standardized phone script to contact patients and a call log to document outcomes. The outcomes measurement was the new-patient no-show rate, calculated by the electronic medical record schedule audits and compared to data from December 2024. Descriptive analysis was used to compare pre- and post- intervention no-show rates.

Results: A total of 58 new patients were scheduled during the implementation period, 4 and 35 (60.3%) were successfully contacted by phone. Among the patients contacted, nine cancelled or rescheduled, and three were no-shows, giving a no-show rate of 8.57%. Compared to the December 2024 baseline no-show rate of 24.4%, the intervention was associated with a 15.83 percentage point reduction, or a 64.88% decrease in missed new patient appointments. Barriers to implementation included incorrect phone numbers, unanswered calls, voicemail unavailability, and an unexpected staff absence requiring the training of replacement staff.

Conclusions: Personal phone call reminders were associated with a reduction in new patient no-show rates at this rural family medicine office, though the target goal of 5% or less was not met during this time period. The intervention was low-cost, with an estimated revenue gain of 147.92 per prevented no-show. Sustainability can be achieved by establishing a policy for provider assistants to call new patients 24-48 business hours before appointments, with potential expansion to all scheduled appointment types. Future projects should consider longer implementation periods outside of the holiday season.

Creative Commons License

Creative Commons Attribution-Noncommercial 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License

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