Reduce Waiting & No-Shows  Increase Admissions & Continuation How did Kings County Hospital increase admissions & retention by decreasing no shows? Janet Aiyeku Sr. Associate Director Behavioral Health – Chemical Dependency Services Kings County Hospital Center Brooklyn, New York

Reduce Waiting & No-Shows  Increase Admissions & Continuation AIM (plan) Change Project To Increase Admissions and Retention by Decreasing No Shows (Promising Practice)

Reduce Waiting & No-Shows  Increase Admissions & Continuation CHANGE (do) Focused on decreasing no shows and made the following changes: Two times a week started outreach to other agencies (e.g. shelter, parole/probation agencies, etc.) [10/09] Streamlined our intake waiting times [10/09] & reduced assessment paperwork [12/09] Started same day admissions & reduced waiting time from two days to four hours [10/09]

Reduce Waiting & No-Shows  Increase Admissions & Continuation CHANGE (do) con’d Began providing a daily orientation instead of monthly [11/09] Provided transportation reimbursement for patients with no Medicaid & helped them apply for Medicaid (if qualified) [11/09] Assigned patients to primary counselor on day of admission [10/09]

Reduce Waiting & No-Shows  Increase Admissions & Continuation RESULTS (study) As result of these changes, we realized several improvements - New forms reduced paperwork by 30% which allowed staff more time to focus on patients Absences were monitored and daily telephone reminder caused decrease in no show Offer same day admission

Reduce Waiting & No-Shows  Increase Admissions & Continuation RESULTS (study) con’d Same day assessments caused admissions increase from 85% to 93% and no show rate continues to decrease from 28% to 15% Revenue increased due to increase in admissions By decreasing the no-show rate, staff time was spent more productively We met/exceeded and sustained OASAS utilization rate of 90%

Reduce Waiting & No-Shows  Increase Admissions & Continuation NEXT STEPS (act) This change project is in sustainability phase Continue to monitor no-shows and admissions Continue to create a culture of performance improvement About to introduce text message/ to patients that are absent more than two days in addition to phone calls

Reduce Waiting & No-Shows  Increase Admissions & Continuation IMPACT (business case, lessons learned) Reducing paperwork increased patients and staff satisfaction Less paperwork allow patients to be serviced in a more timely fashion Providing same day admission created increase in admission which increases revenue

Reduce Waiting & No-Shows  Increase Admissions & Continuation IMPACT (business case, lessons learned) con’d Increase in revenue results in more incentives for staff and patients, including supplies for staff, patient social events: summer picnic, trips etc, staff recognition incentives etc. Reminder calls increase retention rate and improve process Increased patient satisfaction

Reduce Waiting & No-Shows  Increase Admissions & Continuation KCHC Retention for Admissions Increased from % No Show Decreased from 28 – 15% Study Range Sept 2009 – Feb 2010

Reduce Waiting & No-Shows  Increase Admissions & Continuation Admission and No Show Rates to Date Sept 09 – June 10