Using Twilio voice appointment reminders, Arkansas Children’s Hospital delivers crucial care to more children

Nearly 20% of children missed their appointments each day at Arkansas Children’s Hospital, putting their ongoing care at risk. In response, the hospital used Twilio Programmable Voice to set up appointment reminders, making it easy for patients to confirm appointments with a simple voice response of “yes” or “no.”



Savings by switching from inefficient mailing system to Twilio

20 additional children

Receive the care they need each day

Arkansas Children’s Hospital, located in Little Rock, has a clear mission: to improve children’s health by providing integrated patient care, research, education, and preventive care. As the only pediatric medical center in Arkansas and the sixth-largest pediatric hospital in the U.S., the organization has a tremendous responsibility to patients and patients’ families.

In 2012 the hospital faced a challenge. No-shows were common, with nearly 20% of patients missing their scheduled appointments. The hospital needed an efficient way to reduce its no-show rate so that children could get the timely care they needed.

Twilio Products

  • Programmable Voice
  • Programmable SMS


  • Appointment reminders
  • Interactive voice response (IVR)

“[Twilio] has been a massive improvement over the old system I built with a phone card, landlines, a server, and the MS-TAPI.”

Stewart Whaley, team leader of Systems Development Group, Arkansas Children’s Hospital

Keeping patients in the loop with voice reminders

Attending to the hospital’s nearly 400,000 annual outpatient appointments each year requires a significant outlay of time and resources. It takes a team of 500 physicians, 95 residents in pediatrics and pediatric specialties, and 4,400 employees to make sure kids get the care they need every day.

Due to the high fixed costs of operating the facility, the hospital incurs significant losses when patients don’t show up for appointments. With 80,000 annual no-shows, costs add up quickly.

Arkansas Children’s Hospital has long had issues with appointment reminders. The hospital went online with its first phone system in 2006—a single Windows PC with a simple interactive voice response (IVR) dialogue and phone lines. When the hospital sent out hundreds of thousands of appointment confirmation calls, the calls were split between four 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 and resulting in yet another breakdown.

The hospital tried to address the problem a different way in 2012, investing more than $250,000 in sending appointment reminders by mail, but the no-show rate didn’t budge.

Eventually, Arkansas Children’s Hospital turned to Twilio Programmable Voice and SMS to help create proactive appointment alerts. The move freed the hospital from dealing with the fickle, costly on-premises call center along with the $250,000 in mailing costs. “The man-hours for maintenance and support for our old phone system were very high, and vendor solution estimates to replace it were ridiculous,” says Stewart Whaley, team leader of the Systems Development Group at the hospital.

Within weeks, the hospital had appointment reminders powered by Twilio Programmable Voice up and running. Now when patients book appointments, they can opt in to voice reminders. The hospital’s call script will contact patients a day before their appointments, reminding them of the day, time, and location and asking if they’ll show up. If the response is “yes,” the IVR will confirm the appointment time once again and hang up. If they say “no,” the script will remind patients to reschedule and give them a number to call to make a new appointment.

Better communication with staff, fewer no-shows

In the first few months, the new system reduced the no-show rate by 2%, which saved the hospital thousands of dollars and helped ensure that 20 additional children each day received the quality care they needed.

The system also requires less maintenance than the call center. “Once we got Twilio up and running, it required very little upkeep. We’re happy with how the system works, and we haven’t experienced any problems,” Stewart says.

After the initial success, Stewart sought to leverage Twilio further by adding an SMS short code.

“Texting is ubiquitous, everybody does it, and our alerts arrive just in time,” Stewart says. The short code allows the hospital to contact even more patients about their appointments and changes in clinic opening hours, at greater speed and scale.

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

Ultimately, Twilio provides the hospital with deliverability it can rely on, at the scale and speed it needs to get timely updates to patients.


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