Impact of a Direct Bedding Initiative on Left Without Being Seen Rates

Left without being seen (LWBS) rates have become a key metric of emergency department (ED) flow, and high rates have been associated with poor patient outcomes, especially at busy urban, academic hospitals.

To assess a triage intervention's impact on LWBS rates among Emergency Severity Index (ESI) level 2 patients especially at risk for adverse outcomes.

We conducted a retrospective review at an urban academic center of LWBS rates prior to and after a "direct bedding" intervention, which directed patients triaged to ESI level 2 to be immediately placed in any available ED area, including those typically reserved for lower-acuity complaints. Our primary analysis employs an adjusted difference-in-difference-in-difference (DDD) approach using controls from the previous year and a nearby affiliate community hospital that did not participate in the intervention.

Mean daily patient volume increased from 275 to 298 arrivals after the intervention. In the primary DDD analysis, odds of LWBS were lower after the intervention (adjusted odds ratio [OR] 0.56, 95% confidence interval [CI] 0.45-0.70, p < 0.001). LWBS was higher in the unadjusted analysis (unadjusted OR 1.39, 95% CI 1.31-1.49, p < 0.001), but still lower among ESI 1 or 2 patients targeted by the intervention (unadjusted OR 0.56, 95% CI 0.43-0.74, p < 0.001).

"Direct bedding" of ESI 2 patients may expedite care for the sickest patients, reducing potential harm to patients who might otherwise LWBS, without compromising care for patients triaged to less acute ESI levels.