P2421 - Enhancing Anorectal Biofeedback Appointment Completion Rate and Access Through Interprofessional Collaboration: A Quality Improvement Project

Coka Yip, DNP, FNP¹, Bernice Coleman, PhD, ACNP-BC¹, Alisa Ochoa, DNP, FNP¹, Lorna Layaoen, RN, BSN¹, Lourdes Cabili-Lopez, RN, BSN¹, Jocelyn Barragan, RN, BSN¹, Byunghyun Kim, MS¹, Bianca Chang, MD², Ali Rezaie, MD, MSc¹
1Cedars-Sinai Medical Center, Los Angeles, CA; 2Cedars-Sinai Medical Center, Beverly Hills, CA

Introduction: Anorectal Biofeedback is an effective treatment for fecal incontinence and dyssynergic defecation. Despite its efficacy, access remains limited due to the scarcity of specialized centers nationwide. High cancellation rates further exacerbate access issues and reduce efficiency. In 2023, our center scheduled 688 biofeedback appointments, with a completion rate of 45% (n=306), no-show rate was 5% (n=36), and cancellations at 50% (n=346). The average wait time for an appointment was 184 days. This quality improvement project (QIP) aimed to reduce no-show and cancellation rates to under 30%, improve appointment completion rates to over 70%, and decrease the average wait time by 30% to fewer than 129 days by December 31, 2024.

Methods: An interprofessional team conducted monthly meetings to guide changes, track metrics, and assess performance against goals. Interventions included patient reminder calls and texts, training a new nurse practitioner as a biofeedback coach, and expanding appointment availability. The effectiveness of these interventions was evaluated monthly from January 1 to December 31, 2024.

Results:

During the project period, the average wait time for appointments was reduced significantly from 184 days to 89 days, achieving a remarkable 52% reduction and surpassing the initial goal. Among the 1,077 patients scheduled, 43% (n=462) completed their biofeedback appointments, slightly lower than the pre-intervention completion rate of 45%. No-shows increased from 5% to 6.7% (n=72), while cancellations remained at 50% (n=543) (Table 1). Vital elements include optimal staffing, effective interventions such as appointment reminder calls and text messages while several logistical challenges were encountered (Fig 1). While the targets for the average completion, no-show, and cancellation percentages were not met, there was a noteworthy 51% increased of completed encounters from pre- (n=306) to post- (n=462) intervention. In addition to a substantial reduction in wait time, especially in light of the 56% increase in scheduled biofeedback appointments (from n=688 to n=1,077). 

Discussion: While increasing biofeedback slots improved patient access, it did not reduce appointment cancellation rates in this QIP. Future efforts should focus on reducing cancellations and enhancing processes to fill canceled slots promptly, improving therapy access, and mitigating potential revenue losses.


Figure: Fig 1. Run chart of Anorectal Biofeedback completion rates (%) and interventions/events from pre-intervention (January 2023 - December 2023) to post-intervention (January 2024 - December 2024)




Figure: Table 1. Comparison of Number of Encounters (n), Mean (%), and Standard Deviation (SD) for Cancellation, No-Show, and Completed Encounters Before and After Interventions. Chi-square (p= 0.43).

Disclosures:
Coka Yip indicated no relevant financial relationships.
Bernice Coleman indicated no relevant financial relationships.
Alisa Ochoa indicated no relevant financial relationships.
Lorna Layaoen indicated no relevant financial relationships.
Lourdes Cabili-Lopez indicated no relevant financial relationships.
Jocelyn Barragan indicated no relevant financial relationships.
Byunghyun Kim indicated no relevant financial relationships.
Bianca Chang indicated no relevant financial relationships.
Ali Rezaie: Ardelyx, Blueprint Medicine and Salix Pharmaceuticals – Consultant. Gemelli Biotech, and Good LFE – Equity stake.

Coka Yip, DNP, FNP¹, Bernice Coleman, PhD, ACNP-BC¹, Alisa Ochoa, DNP, FNP¹, Lorna Layaoen, RN, BSN¹, Lourdes Cabili-Lopez, RN, BSN¹, Jocelyn Barragan, RN, BSN¹, Byunghyun Kim, MS¹, Bianca Chang, MD², Ali Rezaie, MD, MSc¹. P2421 - Enhancing Anorectal Biofeedback Appointment Completion Rate and Access Through Interprofessional Collaboration: A Quality Improvement Project, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.