Different detection methods identified different adverse events. Findings are consistent with studies that recommend combining approaches to measure patient safety for internal quality improvement. Potential reported adverse event inconsistencies, low association with documented harm and reporting differences across organizations, however, raise concerns about using these patient safety measures for public reporting and organizational performance comparison.

Objective To measure the cost of non-attendance (“no-shows”) and benefit of overbooking and interventions to reduce no-shows for an outpatient endoscopy suite. Methods We used a discrete event simulation model to determine improved overbooking scheduling policies and examine the effect of no-shows on procedure utilization and expected net gain, defined as the difference in expected revenue based on CMS reimbursement rates and variable costs based on the sum of patient waiting time and provider and staff overtime. No-show rates were estimated from historical attendance (18% on average, with a sensitivity range of 12 to 24%). We then evaluated the effectiveness of scheduling additional patients and the effect of no-show reduction interventions on the expected net gain. Results The base schedule booked 24 patients per day. The daily expected net gain with perfect attendance is $4,433.32. The daily loss attributed to the base case no-show rate of 18% is $725.42 (16.36% of net gain), ranging from $472.14 to $1,019.29 (10.7% to 23.0% of net gain). Implementing no-show interventions reduced net loss by $166.61 to $463.09 (3.8% to 10.5% of net gain). The overbooking policy of 9 additional patients per day resulted in no loss in expected net gain when compared to the reference scenario. Conclusions No-shows can significantly decrease the expected net gain of outpatient procedure centers. Overbooking can help mitigate the impact of no-shows on a suite’s expected net gain and has a lower expected cost of implementation to the provider than intervention strategies.