ABSTRACT
COVID-19 has understandably been foremost in our minds over the last year and will continue to be for some time, but it is not the only urgent crisis that individuals, societies, and nations face. This essay looks at current events through the lens of Alvin Toffler’s publication The Third Wave, focusing especially on the accelerative nature of change today and how it increases complexity. Graeme Hawley, Head of General Collections at the National Library of Scotland, considers what accelerative change means in terms of the collections he is responsible for, and the extent to which COVID-19 is likely to impact accelerative change in the immediate future. The essay takes a broad look at topics that, although distinct in themselves, all share the qualities of velocity, and all seem to be happening at roughly the same time so that we can situate the post-COVID world in its fuller context. © 2021 David Baker and Lucy Ellis Published by Elsevier Ltd.
ABSTRACT
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.