Track the patient journey, or lose patients

If you do not know where each patient is between enquiry and their next review, you cannot tell who to call back. What to track, when to reach out, and what the research says it costs to skip it.

A patient's relationship with your clinic is not one visit. It is a journey: they find you, they ask a question, they book, they come in, they get results or treatment, and then, very often, they are supposed to come back.

Most clinics only really track one step of that: the appointment itself. Everything before and after lives in someone's memory, a notebook, or nowhere. That is where patients quietly fall out, and where the money goes with them.

The stages worth tracking

You do not need fancy software to start. You need to know, for every patient, which of these stages they are at:

1. EnquiredThey called, messaged or filled in a form. Did anyone answer?
2. BookedThey have a date. Did they get a reminder?
3. AttendedThey came in. Or they did not, and nobody followed up.
4. Results or treatmentResults came back, or a course of treatment started.
5. Next step dueThe doctor asked them to come back: a review, repeat test, next session.
6. ReturnedThey came back for that review or follow-up.

The stage that matters most is the second last one. Next step due is the moment to reach back out and schedule their review. If you are not tracking it, you will not know it has arrived.

What it costs to skip it

Here is what the research says happens when patients are left to manage their own next step.

• Most patients do not book their own follow-up. In a trial at an emergency department, patients who had their follow-up appointment booked for them before they left went to it 59% of the time. Patients told to call and book it themselves went only 37% of the time (Kyriacou and colleagues, Journal of General Internal Medicine, 2005). In other words, when nobody took the next step for them, 63% of patients who needed a follow-up never got one.
• Reminders bring patients back. A Cochrane review of 72 trials in high blood pressure care found reminder systems got more patients to return for follow-up (Glynn and colleagues, 2010). Another Cochrane review found text message reminders raised attendance by about 14% compared with no reminder, and worked about as well as phone calls (Gurol-Urganci and colleagues, 2013).
• Recall works best by phone. A Cochrane review of 55 studies on patient reminder and recall found it raised the share of patients who came in, with telephone reminders the most effective (Jacobson Vann and colleagues, 2018).

These studies come from hospitals and public health, not private clinics, so treat them as a direction, not a promise for your practice. But the direction is the same in every one: patients who are not followed up drift away, and a simple, timely reach-out brings a large share of them back.

What that means in money

Use your own numbers. As an example only:

• Patients told to come back for a review: 100
• Come back on their own (37%, as in the trial above): 37
• Come back when you book it for them (59%): 59
• Extra visits from tracking and reaching out: 22 a month

Twenty-two visits a month is more than 250 a year, from patients you already have. Multiply by your own average visit fee. The point is not the exact figure. It is that the gap is big, and it is made of patients who already trust you.

How to track it without new software

1. One list. A spreadsheet or your practice system, one row per patient who has a next step: name, phone, what is due, the date it is due.
2. Fill it in at the end of every visit. If the doctor says "come back in three months", the date goes on the list before the patient leaves. Better still, book it there and then, like the trial above.
3. Check it every week. Anyone whose date has arrived or passed, with no booking, gets a call.
4. Close the loop. When they book, mark it. When they attend, mark it. When they say no, note why.

If you have a backlog, start with the notes from the last few months. Our guide on how to get patients for free walks through going through your notes and calling those patients.

The short version

Know where every patient is. The moment a review or follow-up falls due is the moment to call. Clinics that track that moment book the visit. Clinics that do not are waiting for patients who, the research says, mostly will not call first.

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