Attachment D20 - Mental Health No Show Policy.pdf

VA SAN DIEGO HEALTHCARE SYSTEM MENTAL HEALTH CARE LINE – 002

SAN DIEGO, CA January 23, 2020

MENTAL HEALTH PATIENTS FAILURE TO ATTEND APPOINTMENTS (NO-SHOW POLICY)

1. PURPOSE: The Office of Inspector General reviewed Department of Veteran Affairs (VA) Medical Centers’ performance on the following up with Veterans who fail to report for mental health scheduled appointments and issued a recommendation for Veterans Health Administration to follow for patients who failed to show up for appointments.

2. POLICY: This policy describes processes needed for Veterans who missed mental health appointments in the outpatient clinics. This does not include residential rehabilitation settings.

3. DEFINITIONS:

a. LIP - Licensed Independent Practitioner

b. RN – Registered Nurse

c. MSA - Medical Support Assistant

d. A "no show" patient - one who fails to keep a scheduled clinic appointment.

e. Failure to keep a scheduled appointment - not arriving at all or arriving at the

Mental Health clinic one hour after the scheduled appointment without advance notice to the clinic.

4. RESPONSIBILITIES:

a. The ACOS/Mental Health is responsible to ensure employees are knowledgeable of this policy and procedure, and receive training as needed.

b. Section Chiefs are responsible for reviewing no-show data on at least an annual basis for compliance with this policy and update program procedures as needed.

c. Each employee who is within the Mental Health Care Line or supports the Mental

Health Service programs is responsible, without exception, for following this policy.

5. PROCEDURES:

a. A health care provider (preferably the appointment provider) will review all cases of failure to show for an appointment in order to determine if the failure poses a significant risk to the Veteran's health. This will include the provider’s review of the chart, estimation of suicidal risk as low, moderate or high based on available information, and documentation in CPRS.

b. A Veteran who does not show for his/her appointment will not be automatically rescheduled for appointments. Those arriving past their appointment times can be seen or rescheduled based on the provider's availability and clinical judgment.

Every effort will be made on the part of the provider to accommodate the Veteran and to prevent delaying access to treatment.

c. In accordance with the VA’s 12-Point Plan for Mental Health Services, all Veterans who “no show” will receive up to three telephone calls in attempts to reach the Veteran, to ensure he/she remains connected to services.

d. The first call will come from a Licensed Independent Practitioner (LIP; typically, the provider of the missed appointment) or Registered Nurse (RN). This way, clinical issues from the Veteran’s program could be addressed.

e. If the Veteran is not reached during the 1st call, the 2nd and 3rd calls may be placed by Medical Support Assistants (front desk personnel) if the LIP orders.

However, for Veterans on the high risk list (per MCM 11-24), all 3 calls must be placed by an LIP or RN, typically the individual with whom the appointment was scheduled. If contact is unsuccessful for a high risk patient, a welfare check with local police may be indicated. Staff members should contact the suicide prevention coordinators for guidance and/or additional actions.

f. For all no-show occurrences, a separate “non-count” progress note in CPRS will be written for each “no show” call placed to allow for auditing of the calls.

(1) The first note should state: “I attempted to reach the Veteran by telephone but did not speak to him/her. I left a discreet message with my office number asking him/her to contact me at the VA.” The LIP may use his/her own wording.

(2) Second notes should add: “I asked the Veteran to contact me by [DATE] to verify that the message has been received.” The 3rd note should state the same, UNLESS Veteran has a high-risk for suicide flag AND is deemed to be at imminent risk for harm, in which case 3rd note is this: “I was unable to reach the Veteran by telephone after 3 attempts, and s/he has not returned the calls after messages were left.” The note should then indicate next steps taken by the LIP, including asking the police to conduct a ‘welfare check’, consulting with the Suicide Prevention team, or other appropriate steps, and provide a brief rationale. The LIP may use his/her own wording.

g. Providers will ensure that the appointment has been designated as a no-show before the note is written, so it does not erroneously check the patient as having arrived.

h. Providers will inform Veterans of this no-show policy when starting Mental Health services, and to make every attempt to arrive to scheduled appointments or to notify the clinic in advance.

i. For Veterans on the high risk list, it is recommended that they be informed of the policy to conduct a welfare check as necessary if they do not respond to the 3 no-show follow up phone calls.

j. This policy will not replace sound clinical judgment in management of Veteran care.

k. Veterans who do not present for appointments during times of severe inclement weather or disasters (e.g., wildfires) will not be considered a “no-show”.

l. Compliance with this policy and related procedures will be monitored at least by the Section Chiefs. Feedback will be provided to the Mental Health Leadership every two years, or earlier if needed. Section Chiefs will provide timely feedback, guidance and corrective actions to staff when appropriate. Audits should consist of reviewing a minimum of five no show cases within each quarter, review the CPRS notes related to calls made and other actions taken to reach the Veteran.

6. REFERENCES:

a. MCM 11-24: IDENTIFICATION, ASSESSMENT AND MANAGEMENT OF

VETERANS AT RISK FOR SUICIDE. Found at:

http://vaww.docushare.visn22.med.va.gov/dsweb/Get/Document-47909/MCM_11-

24_ASSESSMENT_AND_MANAGEMENT_OF_PATIENTS_AT_RISK_FOR_SUIC

IDE_revision_7_24_13.doc.

b. Uniform Mental Health Services Handbook 1160.01

c. Deputy Under Secretary for Health for Operations and Management (10N) memorandums dated, June 25, 2013 and August 6, 2013.

7. REVIEW DATE: January 2023

8. FOLLOW-UP RESPONSIBILITY: Office of Mental Health and Mental Health Section

Chiefs

9. RESCISSION: MHCL Policy 002 dated August 17, 2017

10. APPROVED BY CORE: January 24, 2020

1/24/2020

X Niloofar Afari, PhD Niloofar Afari, PhD ACOS/Mental Health Signed by: people

Attachments: None Distribution: Mental Health Sharepoint http://vaww.docushare.visn22.med.va.gov/dsweb/Get/Document-47909/MCM_11-24_ASSESSMENT_AND_MANAGEMENT_OF_PATIENTS_AT_RISK_FOR_SUICIDE_revision_7_24_13.doc http://vaww.docushare.visn22.med.va.gov/dsweb/Get/Document-47909/MCM_11-24_ASSESSMENT_AND_MANAGEMENT_OF_PATIENTS_AT_RISK_FOR_SUICIDE_revision_7_24_13.doc http://vaww.docushare.visn22.med.va.gov/dsweb/Get/Document-47909/MCM_11-24_ASSESSMENT_AND_MANAGEMENT_OF_PATIENTS_AT_RISK_FOR_SUICIDE_revision_7_24_13.doc http://vaww.docushare.visn22.med.va.gov/dsweb/Get/Document-47909/MCM_11-24_ASSESSMENT_AND_MANAGEMENT_OF_PATIENTS_AT_RISK_FOR_SUICIDE_revision_7_24_13.doc http://vaww.docushare.visn22.med.va.gov/dsweb/Get/Document-47909/MCM_11-24_ASSESSMENT_AND_MANAGEMENT_OF_PATIENTS_AT_RISK_FOR_SUICIDE_revision_7_24_13.doc http://vaww.docushare.visn22.med.va.gov/dsweb/Get/Document-47909/MCM_11-24_ASSESSMENT_AND_MANAGEMENT_OF_PATIENTS_AT_RISK_FOR_SUICIDE_revision_7_24_13.doc