What is the recommended follow-up protocol for patients who miss psychiatric telehealth appointments?

Follow-Up Protocol for Psychiatric Telehealth No-Shows

For patients who miss psychiatric telehealth appointments, at minimum one documented phone call attempt should be made to ensure patient safety and continuity of care, as missed appointments may indicate clinical worsening or crisis. 1

Risk Stratification for Follow-Up

The intensity of follow-up should be based on patient risk factors:

High-Risk Patients (Require Aggressive Follow-Up)

• Patients with:
  • Known suicide risk
  • Recent suicidal ideation or attempts
  • Severe psychiatric symptoms
  • Recent medication changes
  • History of poor adherence
  • Unstable social situations 1

Lower-Risk Patients

• Patients with:
  • Stable symptoms
  • Good medication adherence
  • Strong social supports
  • No recent suicidal ideation 1

Follow-Up Protocol Algorithm

1. Initial Response (Same Day)

   • Make at least one phone call attempt 1
   • If no response, leave a voicemail (if possible) with clear instructions to call back
   • Document the attempt in the medical record

2. Secondary Response (Within 24-48 Hours)

   • For high-risk patients:

     • Make additional phone call attempts
     • Consider contacting emergency contacts if clinically indicated 1
     • Consider home visit for highest-risk patients (home visits have been shown to be most effective in preventing subsequent missed appointments) 2

   • For lower-risk patients:

     • Send follow-up communication (letter, secure message)
     • Schedule automatic reminder for next follow-up

3. Documentation Requirements

   • Date and time of missed appointment
   • All follow-up attempts made
   • Content of any communication
   • Assessment of risk if contact was made
   • Plan for next steps 1

Importance of Follow-Up

Research demonstrates that lack of follow-up after missed appointments significantly impacts patient outcomes:

• Patients without follow-up after missed appointments are more likely to require emergency services 2
• Three or more outpatient visits within 60 days after hospital discharge reduces rehospitalization risk by 43.3% within 90 days 3
• Continuous outpatient treatment is crucial for relapse prevention 3

Common Reasons for Missed Appointments

Understanding why patients miss appointments helps tailor follow-up approaches:

• Forgetfulness (69% of missed appointments) 4
• Work commitments (16.7%) 4
• Transportation issues (4.8%) 4
• Financial constraints (6%) 4
• Clinical symptoms 5
• Motivational concerns 5
• Negative treatment reactions 5

Establishing Therapeutic Relational Connection in Telehealth

When reconnecting with patients who missed appointments:

• Ensure the environment is suitable for telehealth (lighting, camera placement, privacy)
• Take time to understand the patient's circumstances
• Maintain eye contact and use appropriate body language to convey empathy
• Use active listening throughout the interaction
• Address any technical difficulties that may have prevented attendance 6

Common Pitfalls to Avoid

• Relying solely on automated reminders - Insufficient for psychiatric care as clinical deterioration may be occurring
• Assuming no response means the patient is fine - Lack of response could indicate worsening symptoms
• Not considering technical barriers - Some patients may need assistance navigating telehealth platforms
• Failing to document follow-up attempts - Critical for continuity of care and liability concerns 1

Implementing a structured follow-up protocol for telehealth no-shows is essential for maintaining therapeutic relationships, ensuring patient safety, and preventing clinical deterioration in psychiatric care.