Early quick acuity score provides more complete data on emergency department walkouts

Area of Science:

• Emergency Medicine
• Healthcare Operations Research
• Patient Flow Management

Background:

• Prior studies comparing Left Without Being Seen (LWBS) and non-LWBS patients in Emergency Departments (EDs) are limited by potential bias from patients leaving before triage.
• A novel operational change involved assessing patient acuity immediately upon arrival to mitigate this bias.

Purpose of the Study:

• To evaluate the impact of an Early Quick Acuity Score (EQAS) on the proportion of patients receiving acuity scores.
• To compare characteristics of LWBS and non-LWBS patients with reduced bias using the EQAS system.

Main Methods:

• Retrospective cohort study at an urban academic medical center.
• Compared data from a Traditional Acuity Score (TAS) period (April 2010–March 2012) with an EQAS period (November 2011–March 2012).
• Analyzed patient disposition (LWBS vs. non-LWBS), acuity scores, demographics, and prior ED visit/walkout history.

Main Results:

• EQAS implementation increased overall acuity score recording from 97.6% (TAS) to 99.3% (EQAS).
• Acuity score recording for LWBS patients significantly improved from 73.6% (TAS) to 88.8% (EQAS).
• LWBS patients were more likely to be male, younger, have lower acuity, and had higher rates of prior ED visits and walkouts compared to non-LWBS patients.

Conclusions:

• The EQAS system effectively increased the proportion of patients with recorded acuity scores, particularly for LWBS individuals.
• This operational change provides more complete data for analyzing differences between LWBS and non-LWBS patient populations.
• Findings from prior studies comparing patient characteristics were reinforced with less bias.