Follow-Up Protocol for Psychiatric Telehealth No-Shows
Yes, you are required to make a follow-up call to patients who no-show for psychiatric telehealth appointments as part of standard operating procedures to ensure patient safety and continuity of care. 1
Rationale for Required Follow-Up
Psychiatric patients represent a vulnerable population with potential risks that require monitoring:
- Mental health conditions can deteriorate rapidly without appropriate care
- Missed appointments may indicate clinical worsening or crisis
- No-shows could represent suicide risk or medication non-adherence
- Follow-up demonstrates therapeutic relational connection in telehealth 1
Structured Follow-Up Protocol
Immediate Response (Same Day)
- Make at least one documented phone call attempt to the patient
- Leave a voicemail if possible, stating:
- Acknowledgment of the missed appointment
- Request to reschedule
- Instructions for emergency situations
- Your contact information
If Unable to Reach Patient
- Document all contact attempts in the medical record
- Consider contacting emergency contact if clinically indicated (especially for high-risk patients)
- For patients with known suicide risk, more aggressive follow-up may be necessary 1
Documentation Requirements
- Date and time of missed appointment
- Follow-up attempts made (calls, messages)
- Content of any communication
- Assessment of risk if contact was made
- Plan for next steps
Risk Stratification Approach
High-Risk Patients (require more aggressive follow-up)
- Recent suicidal ideation or attempts
- Severe psychiatric symptoms (psychosis, mania)
- Recent medication changes
- History of poor adherence
- Unstable social situation
Standard-Risk Patients
- Stable symptoms
- Good medication adherence
- Strong social supports
- No recent suicidal ideation
Common Pitfalls to Avoid
- Relying solely on automated reminders: These are insufficient for psychiatric care where clinical deterioration may be occurring
- Assuming no response means the patient is fine: Lack of response could indicate worsening symptoms
- Inconsistent documentation: Failure to document follow-up attempts creates liability
- Over-reliance on "no-suicide contracts": These have no empirical evidence supporting efficacy 1
Telehealth-Specific Considerations
- Technical difficulties may have prevented attendance - assess this during follow-up
- Privacy concerns may have interfered with appointment attendance 1
- Some patients may need assistance navigating telehealth platforms 1
- Consider offering alternative modalities (phone vs. video) if barriers are identified
Following these structured protocols ensures appropriate clinical care while managing liability concerns. The primary goal is always patient safety and continuity of care, particularly important in psychiatric practice where missed appointments can represent significant clinical deterioration.