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Arkansas Children's Hospital saved $250K with over-the-phone appointment reminders

Pediatric hospital uses Twilio Voice to improve patient care with lower costs and 90% fewer missed appointments.

The Results
Decrease in missed appointments
Appointments per year
Appointment no-show rate

Arkansas Children’s Hospital is on a mission. As one of the largest pediatric medical providers in the US, it is focused on pioneering pediatric patient care, researching cutting edge treatment, and saving lives. The team champions children by making them better today and healthier tomorrow.

Helping children stay healthy

The work of the Arkansas Children's Hospital is no small task. It takes a team of 370 beds, 500 physicians, 95 residents in pediatrics and pediatric specialties, and 4,400 employees to make sure kids get the care they need every day. But the hospital can only help patients that show up for their appointments. When patients no-show, it costs the hospital a tremendous amount of time and money. Worst of all, a missed appointment can negatively affect a child’s care and recovery.

Arkansas Children’s Hospital used Twilio to reduce its no-show rate, which saved the hospital $250,000 and freed it from dealing with a fickle, costly, on-premises call center. Most importantly, its new Twilio-powered appointment reminder service helped the hospital directly meet the needs of patients, so everyone receives exceptional care.

Legacy system cracked under the load

Arkansas Children’s Hospital went online with its first phone system in 2006—a single Windows PC with a simple IVR dialogue, and phone lines. When the hospital sent out hundreds of thousands of appointment confirmation calls, the calls were split between 4 phone lines. The system would chronically break down under the call load, only contacting a small percentage of patients. The patients who didn’t get a call reminder would be added to the next call load, putting more stress on the system, resulting in yet another breakdown. The process was cyclical and incredibly frustrating, according to Stewart Whaley, a team leader of the systems development group at the hospital.

Whaley searched for a new solution, but quickly grew tired of sky-high price quotes from vendors and being told to wait months and months. “They had so many systems that didn’t talk to each other and were never ready,” said Whaley. He sat through 4 or 5 demonstrations from different on-premises vendors only to realize he could hire a full-time developer to do nothing but programming for less than the cost of the vendor’s solution.

Whaley also considered building an Asterisk powered notification system, so IT could control everything in-house. However, Asterisk left them with too much responsibility over the call center. Whaley didn’t want to deal with the hassle of a call center’s hardware. The maintenance would take valuable time away from his team that they’d otherwise be using to streamline other operations at the hospital.

“We’re not telecom engineers. We’re programmers,” said Whaley. After a fruitless search for a vendor, Whaley wasn’t expecting to find a solution to his communication problem at DrupalCon. When he saw a Twilio demo at the conference, he knew he had stumbled on something the hospital—and its patients’ families—could truly use.

Twilio a massive improvement

“[Twilio] has been a massive improvement over the old system I built with a phone card, landlines, a server, and MS-TAPI,” said Whaley. After returning from DrupalCon, Whaley whipped up a proof of concept to show the hospital staff. To the staff, shipping hospital data into the cloud was a “mind blower.” To give them faith the system would work, Whaley scheduled a meeting about the Twilio integration. He then built a Twilio-powered system that sent each attendee a SMS reminder about the meeting. When Whaley was asked, “Will the system work?” he simply replied, “Did you get the meeting reminder?” The answer was yes to both questions.

Now when a patient books an appointment, they can opt in to sms or voice reminders. The hospital’s call script will contact patients a day before their appointment reminding them of the day, time, and location, and asking them if they’ll make the appointment. If the response to the call is “yes,” the IVR will confirm the appointment time once again and hang up. If they say “no” on the call, the script will remind the patient to reschedule, and give them the number to call to make a new appointment.

Arkansas Children's Hospital also recently launched a broadcast message system. This system provides a web UI for outpatient administrators to build, schedule, and deliver phone calls for groups of patients scheduled for an appointment in any of their 5 clinic locations, informing them of changes in opening hours.

The right message at the right time

“Once we got Twilio up and running, it’s required very little upkeep. We’re happy with how the system works and we haven’t experienced any problems," said Whaley. With 400,000 outpatient appointments a year, getting the right message out at the right time is critical to patients’ treatment, and the hospital’s bottom line. Twilio provides the hospital with the deliverability it can rely on, the scale it needs, and the speed it requires to get timely updates to patients.

Once we got Twilio up and running, it’s required very little upkeep. We’re happy with how the system works and we haven’t experienced any problems.

Stewart Whaley, Team Leader, Systems Development Group, Arkansas Children's Hospital

In 2012, the hospital’s no-show rate was stuck at 20%, over 250 per day. Since the hospital started using a Twilio-powered solution last year, it has reduced the no-show rate to 2%, saving the hospital thousands.

Whaley also reports that the hospital spends less time communicating the same information to different staff members. Now at the start of each day, hospital staff can see a report of which patients confirmed their appointment and who said they wouldn’t make it.

Whaley is currently researching how to leverage Twilio even further, with an SMS short code. "Texting is ubiquitous, everybody does it and our alerts arrive just in time,” says Whaley. The new short code will allow the hospital to contact even more patients about their appointments and changes in clinic opening hours, at greater speed and scale.