Missed appointments in a Canadian tertiary care, academic centre pediatric ophthalmology and adult strabismus service: rates and financial impact

Introduction: Missed appointments are barriers to health care delivery that result in loss of revenue and disruption of physician-patient relationship. There is a paucity of data describing the rate and impact of missed appointments in Pediatric Ophthalmology. Methods: A retrospective review of 3,922 patient appointments for two pediatric ophthalmologists at an academic Canadian institution was conducted over one year. Demographic data included patient age, day and appointment month. Results: There were 720 missed appointments (18.4%), the equivalent of 26.7 full day clinics. New patients were significantly more likely to miss appointments (P < 0.001). There was no difference between patient age (P = 0.46) or day of week (P = 0.16). There was a significant difference between appointment month (P = 0.001), the highest rates were January (26.39%) and February (23.11%). Subset analysis of 1574 patients (one of the providers) revealed surgical strabismus patients were significantly more likely to attend appointments (P < 0.001). Patients were more likely to miss appointments if they previously missed appointment(s) (P < 0.001) or were referred by nurse practitioners (P = 0.027). There was no difference between sex (P = 0.111), distance to clinic (P = 0.073) or appointment time (P = 0.347). The average physician billing loss was estimated at $54,722.46 USD in 1 year. Conclusion/Relevance: This study identifies factors that can be targeted to improve missed appointments. New patients, non-surgical patients and patients referred by nurse practitioners have higher missed appointment rates. Missed appointments cause significant financial loss, physician time wasted, and increase in patient wait times. In the current COVID-19 environment, reduced clinic capacity makes it essential to reduce missed appointments and associated financial loss.