1. Name Oisin Friel Location Ryde Drug & Alcohol Services
Pretreatment dropout
from outpatient
substance abuse clinic
Name Oisin Friel
Location Ryde Drug & Alcohol Services

2. Mission Statement Project Aim: Time frame:
Reduce the number of clients by 25% who
fail to attend for scheduled first appointment
Time frame:
Proposed commencement date:7/07/08
Anticipated completion date: 7/09/08
Date of Review of Outcomes of Project: 8/12/08

3. Team Members & Role Guidance team member:
Oisin Friel
Project team members with fundamental knowledge and who worked on the project:
 Oisin Friel,  Sue Weston,
 Linda Miller,  Barbara Jane Murray,
 Loretta Elkins,  Karen Hanzal-Jones

4. Evidence for there being a problem worth solving
An monthly audit was conducted of clinician’s diaries for
2007 to determine the number of kept appointments in
relation to scheduled appointments arranged for new
clients to the service.
380 allocated appointments of one hour duration were
reserved for new clients from January to December.
The study revealed a 33% ‘failed to attend’ rate in the twelve month period.

5. Failed to attend rate 2007 (33%)

6. Evidence for there being a problem worth solving
Clinicians experienced frustration due to:
Time wasted waiting for client to attend appointment
Uncertainty about why clients failed to attend appointment
Inability to attend to other work responsibilities
Difficulty in organising work diary events

7. High Order Flow Chart of Intake Process
Development of drug problem
Decision to consult GP
Inability to resolve problem
GP confirms problems is serious
Referral to D&A service
Contact D&A service
See clinician for assessment
Receive treatment
Follow up care
Discharge

8. Detailed Flow Chart of area of Interest
Leaves message on voice mail
Service returns call x 2
Message left
Client contacts service
Speaks to intake officer
Confirms client’s request for this service
Intake form completed
Check for next available appointment
Appointment made with clinician
Appointment typed into computerised diary
If other service requests appointment client must call to confirm
Client calls to confirm
Client given service details, date, time etc
Completed intake form filed
Client arrives / CTC / FTA
If CTC new appointment arranged

9. Process Improvement Exercise
Brainstorming possible reasons for problem
Multivoting
All team involved
Group similar ideas / concepts together
Secret ballot voting to choose biggest problem areas
Represent as Ishikawa diagram (fishbone)

10. Cause and effect diagram
Family / Money
Motivation
Other
Missed the bus
Shame
Problem resolved
Anxious
No transport
Crisis passed
Scared
Kids sick
Slept in
Too hard
Too awkward to find place
Too wet
Not ready
Assaulted
Couldn’t be bothered
No money to get there
Too cold
Client fails to show for appointment
Too unwell
Didn’t write appointment down
In jail / hospital
Drug, alcohol affected
Had another appointment
No one told me
Too busy
Forgot appointment
Psychosis
Partner forbade it
Got date/time wrong
Coerced
Self harmed
Confusion
Got new job
Co morbid problems
Cognitive Impairment
External agencies

11. Pareto Analysis Sheet Category Frequency Percentage Cumulative %
Shame/fear 9 26
Lack of
motivation 8 22 48
Forgot
appointment 6 17 65
Overslept 5 13 78
Co morbid problems 4 11 89
Crisis passed
100
Total 36

12. Reasons for failure to attend scheduled appointment
Pareto Chart
Reasons for failure to attend scheduled appointment

13. Intervention Clinicians to call clients prior to assessment date to:
Introduce oneself to client
Confirm appointment date and time
Develop initial rapport
Alay anxiety about coming to service

14. Intervention Implementation period: Two months All clinicians involved
Data collected by admin assistant
APPOINTMENTS SCHEDULING LOG (7/7/08 – 7/9/08)
Client Identifier
Date of Client Call
Date of Scheduled Appointment
Did Client keep Appointment?
If CTC date of new appointment 1
2/7/08
8/7/08
Yes 2 No
15/7/08 3
3/7/08
9/7/08

15. Outcome of Study

16. Strategies to Sustain Improvement
Incorporate the changes made into the intake
process
Alter the method by which clinicians are
notified of new clients placed in their
computerised diaries so as to alert them to call
the client prior to appointment time
Monitor strategy on a monthly basis

17. Other PDSA Cycles to consider
Reduce the lag time to first appointment
Monitor dropout rate post assessment
Record reasons clients give for cancelling
appointments
Stay linked to the ACTION Campaign
( to review research
into addiction treatment improvements