Date Available


Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Nora Warshawsky

Clinical Mentor

Dr. Joel Knight

Committee Member

Dr. Diana Inman


Background: Hospital and outpatient clinic no-show, did not cancel or did not attend rates are a serious problem to organizations across the United States health care system. No-show appointments reduce clinic productivity, wastes clinician time and clinic resources and can be detrimental financially. Bluegrass Pediatrics and Internal Medicine (BPIM) located in Georgetown, KY experiences these problems on a daily basis.

Purpose/Methodology. This quality improvement project consisted of evaluating the effects of text messaging on appointment attendance during 3 clinic weeks of February 2016. The sample was derived from all patients enrolled at BPIM with a scheduled well, established or routine exam (n=577); acute or sick appointment types are excluded. Text message reminders were sent 24 hours prior to appointment time and patients were instructed to respond with a text message: “C” to confirm their appointment. Appointment attendance, cancellations, and no-shows were measured for the study period, 3 weeks prior, and 3 weeks following the study period.

Findings: The overall percentage of no-show appointments for December 2015, February 2016 and March 2016 was 12%, 10% and 13% respectively, showing a 2% decrease between the pre-intervention and study period. Of 577 appointments sent a text message, 39% replied confirming their appointment, while 61% did not reply to the text message. Of those who confirmed their appointment, 82% attended; 58% of those sent a text message and did not confirm their appointment, actually did attend their appointment; 42% of those sent a text message and did not confirm their appointment, also did not attend their appointment. Cost-benefit analysis yielded a potential 1:6 return. Findings show text messaging is effective in reducing no-show appointments and is cost beneficial.

Implications. Technology including text messaging is becoming common practice and its use is supported by current evidence-based research. Utilizing high-tech methods such as text messaging reduces no-show rates, is cost-effective and increases clinic and provider productivity.