DNKA (Did Not Keep Appointment)

November 27, 2013

As TRI-Lab moves into the project development stage, Natalie Posever ’14 reflects on the “Pre to Three” group’s process to date.

The electronic medical records system at Hasbro Children’s Hospital, eClinicalWorks, has always been a mystery to me. During my time volunteering in the pediatric primary care clinic, I sit and watch the computer screen as names switch places, don bright blue highlights, and get numbers and codes tacked on next to them, all in a seemingly random fashion. As I study the display I try to block out the carefully choreographed dance; what most interests me is the numbers that sporadically appear under the column titled, “room,” indicating where I can go to give out our screening form. There are more than enough patients to keep me occupied, as I frantically speed shuffle (no running!) from one end of the clinic to the other. It’s not until the end of my shift when I sit back down to tally the number of screens handed out, that the names fall into place long enough to expose the blank spaces marking the names of patients who never came to their appointment. Lots of spaces, each one representing a child.

“We estimate the DNKA (Did Not Keep Appointment) rate to be around 18% at Hasbro.” Dr. Vivier, a pediatrician at Hasbro, said, responding to our questions about issues affecting the low-income patients at the clinic.

Dr. Vivier, together with two stellar community partners, three other curious students and myself, make up the “Pre to Three” project team within TRI-Lab. Our focus is on improving services for high-risk mothers and mothers-to-be. “Pre to Three” alludes to the age range we are honing in on; we want to ensure children are as healthy as they can be from the prenatal period to age three, as this period is absolutely critical to a child’s future development.

Incidentally, one of the project ideas we are considering seeks to investigate what is behind the high DNKA rates at Hasbro, a question I often find myself contemplating while looking at eClinicalWorks. Is it a lack of transportation? Forgetfulness? Lack of child care? We hope to identify contributing factors to low-income parents not bringing their children to pediatric appointments, and design innovative solutions both to draw patients in and to get the most out of time spent at the clinic.

This is exactly what I had hoped TRI-Lab would be, a bridge connecting faculty, community partners, and students; Brown and Providence; academic work with community work. It’s inspiring to sit in the TRI-Lab space, surrounded by frighteningly brilliant, incredibly driven people looking to make an impact on children’s health. I cannot wait to see what comes of all of our projects as we work to fill in the blank spaces that unfortunately mark the lives of low-income young children all too often.