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Through-the-Wall Blood Sampling Method to Minimize Sleep Disruption in Clinical Settings
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Identifying Patient Door-to-Room Goals to Minimize Left-Without-Being-Seen Rates.

Shea Pielsticker1, Lori Whelan2, Annette O Arthur1

  • 1University of Oklahoma College of Medicine, Oklahoma City, Oklahoma.

The Western Journal of Emergency Medicine
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To reduce emergency department (ED) leave-without-being-seen (LWBS) rates, maintain DoorRoom time (patient presentation to exam room) under 20 minutes. Longer intervals significantly decrease the likelihood of meeting the LWBS goal of less than 1%.

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Area of Science:

  • Emergency Medicine
  • Healthcare Operations Research
  • Health Services Research

Background:

  • High leave-without-being-seen (LWBS) rates in emergency departments (EDs) lead to inefficiency, medical risks, and financial losses.
  • Hospitals aim to maintain LWBS rates below 1% to ensure quality care and operational efficiency.
  • The interval between patient presentation and placement in an exam room (DoorRoom time) is a critical operational metric.

Purpose of the Study:

  • To assess the impact of prolonged DoorRoom times on LWBS rates in an ED.
  • To identify specific DoorRoom time cutoffs that maximize the likelihood of achieving the target LWBS rate of <1%.
  • To provide data-driven performance goals for ED operations.

Main Methods:

  • A retrospective analysis of one year of ED operations data (annual census ~50,000).
  • DoorRoom times were categorized into intervals (≤10 min to >60 min).
  • Multivariate logistic regression adjusted for patient acuity and operational factors to identify significant DoorRoom cutoffs predicting LWBS rates.

Main Results:

  • A DoorRoom time cutoff of 20 minutes was identified as crucial for maintaining a high likelihood (>85%) of meeting the LWBS goal.
  • A secondary cutoff at 35 minutes was indicated to prevent a sharp decline in the likelihood of meeting the LWBS goal.
  • Days with DoorRoom times between 21-35 minutes were 74% less likely to meet the LWBS goal compared to DoorRoom times ≤20 minutes.

Conclusions:

  • Operationally relevant DoorRoom time cutoffs can be established to effectively minimize LWBS.
  • Setting performance goals based on identified DoorRoom time thresholds can improve ED efficiency and patient safety.
  • The study provides actionable insights for EDs striving to reduce LWBS rates.