Here are the responses to the following question: "I am interested in how other HCH programs are scheduling dental. We have a large no show rate and have made little progress in cutting it down."

1. We don’t know if this is unique, but we double book by chairs. So if we have one chair for certain procedures and then a second chair for certain smaller procedures, they are double booked and seen as doable in the event that both/all patients show up. We also use the walk-ins to fill up the no shows. We find that walk in patients with emergency dental needs will wait and not complain as long as they know they will be seen by the dentist.

2. We also have a rather high no-show rate at our clinic. In the past, we have sent out letters to patients who miss appointments reminding them of our appointment policy which requests a 24 hour notice for canceling appointments, and if patients habitually fail their appointments, we have dismissed them.

However, what we mostly do is try to compensate in other ways. We see many emergency patients/day. We triage them and then those that need to be seen immediately, we will schedule them in during the day as we have patients fail. That way, we are still being productive, and serving patients in the slots of the people who have not shown up.

And of course, we book a very tight schedule so that when we do have a fail, we are still very busy, and can do additional work on some people if we have the time.

Currently, we are developing an orientation video to our clinic and how it works, and will be stressing in that the importance of keeping the appointments that are set aside for each patient.

3. Enforcing this policy has made a big difference. Our no show rate is 13% and still improving. (see attachment ")

4. SET UP A DIABETIC DAY. ALSO, OUR DENTAL DEPT IS SCHEDULING PATIENTS WHO NOW SHOW ON A PARTICULAR DAY AND OVERBOOKING THEM SO IT DOES NOT BUT A DRAIN ON THE SYSTEM.

5.We’ve had the experience that reminder calls the day before, for those we can reach live, cuts our no-show rate by about half. We’re also moving toward “Open Access,” and believe that’s also helping, although we can’t yet prove it.

6. I can give you a brief overview of how we have approached the problem; if you want more detail you can call me. We of course confirm each apt as I am sure that you already do. We take emergency patients, approximately 10 to 15 per day. We use these patients to fill in the voids in the schedule. We have a quick call list of patients that are willing to come in on short notice. We try to orientate our patients on their first visit so that they know our policy and the consequences of missed

7. We have Dental on site, and the Dental coordinator is part of our team. Dental makes our Diabetics a priority, the doc makes a referral and one of us will walk the patient over to dental and make the appointment.We have done this as a PDSA cycle to improve our Dental visits.We are a small rural clinic (three providers) and it is fairly easy to do this. I suppose it would be more difficult in a larger facility.