Yes. A patient who misses a follow up visit is not necessarily a patient who no longer needs care, and a recall sequence makes sure someone reaches them. In GoHighLevel the Appointment Status trigger starts a sequence of a text, a call task, and a letter, with a clinician owning outreach when the follow up is clinically urgent. The bottom line: most missed visits are forgotten, not refused, so a prompt, specific, low pressure reminder does most of the work, and a person handles the rest.
Why follow ups are missed
A randomized trial registered on ClinicalTrials.gov, run in an urban emergency department, notes that patients discharged to outpatient follow up fail to attend about 30 percent of scheduled visits, and that they most often report forgetfulness or confusion about dates, times, or locations. The trial tested text reminders with date, time, and location 7, 3, and 1 day ahead. The Community Preventive Services Task Force's finding on reminder and recall adds that these systems reach large numbers of patients at low cost. A missed follow up is also a test result problem: a peer reviewed study of 5,434 records in 23 practices found 7.1 percent of abnormal results had no documented notification, and that practices with simple processes for managing results had lower failure rates.
The sequence
| Day | Step | Owner |
|---|---|---|
| 0 | Text a reschedule link, generic wording | Workflow |
| 3 | Call task, with the patient's number and the visit type | Front desk |
| 7 | Second text, and a letter if there is no answer | Workflow and front desk |
| 14 | Task for the clinician to review the chart and decide next steps | Clinician |
| 30 | Close the loop: document attempts, or mark the patient as declined follow up | Office manager |
The clinician review matters. A missed follow up for a blood pressure check is different from a missed follow up for an abnormal imaging result. The workflow cannot tell them apart, so flag urgent follow ups in a field, such as Follow up priority, and route those to the clinician at day 0, not day 14.
Build it in GoHighLevel
HighLevel help center pages describe the Appointment Status trigger as firing when an appointment is created or its status changes, with statuses New, Confirmed, Cancelled, Showed Up, No Show, and Invalid, and with filters for calendar, calendar group, tag, user, and who made the change (customer, user, or API). The Update Appointment Status action can set the same statuses from inside a workflow. A third party agency guide adds that Appointment Status is now the main appointment trigger and the older Customer Booked Appointment trigger is being phased out, so use Appointment Status for new builds.
- Create a field, Follow up priority, with the values Routine and Urgent, set by the clinician when the follow up is booked.
- Build a workflow with the Appointment Status trigger set to No Show or Cancelled, filtered to follow up calendars.
- Add an If/Else on Follow up priority. Urgent goes to a clinician task at once.
- For routine, send the text, wait 3 days, and create the call task if the patient has not rebooked.
- Add the second text, and the letter task at day 7.
- Add a clinician review task at day 14, and a closing task at day 30 to document attempts.
- Turn on Stop on Response.
Worked example
For example, if a practice books 300 follow ups a month and 15 percent are missed, that is 45 patients (300 times 0.15). If the sequence reaches 30 of them, 30 patients get care they would have skipped, and the 15 who remain have a documented attempt.
Mistakes to avoid
- Treating every missed follow up the same. Urgent ones need a clinician.
- Texting the reason for the visit. Keep it generic.
- No documentation of attempts. Record each contact attempt in the chart.
- Stopping at one text. Add a call and a letter.
How this was handled before
A nurse reviewed a list of missed visits when time allowed, and the practice relied on patients to call back. Studies of test result follow up show that this kind of manual process fails some share of the time, which is why simple, consistent processes are recommended.
What to measure after launch
Track missed follow ups, patients rebooked, urgent follow ups reviewed by a clinician, and attempts documented. Review urgent follow ups weekly.
Check before you switch it on
US text messages sent from a standard 10 digit number need A2P 10DLC registration. The HighLevel support portal says registration is required for texts to US recipients from 10 digit long code numbers and that toll free numbers do not require it. HighLevel's opt in guidelines also say a person cannot be forced to agree to text messages in order to submit a form, so keep the consent box optional. One compliance guide separates informational texts, which need documented consent, from marketing texts, which need prior express written consent. Ask your attorney which category your reminders fall into. Have your medical director approve the urgency rules and the letter, and confirm that outreach about treatment is documented in the record. This is general information, not legal advice.
Questions people ask
Why do patients miss follow up visits?
A trial description reports forgetfulness or confusion about dates, times, or locations as the most common reasons.
Should urgent follow ups use the same sequence?
No. A clinician should own outreach when the follow up is clinically urgent.
How common are missed notifications of abnormal results?
A study of 23 practices found 7.1 percent of abnormal results had no documented notification.
Ready to try it yourself? Start a GoHighLevel account here.
You can also see this in action in our GoHighLevel capabilities demo.