Reduced left-without-being-seen rates and impact on disparities after guest services ambassadors implementation

Area of Science:

• Healthcare Operations
• Patient Experience
• Health Equity

Background:

• Emergency department (ED) leave without being seen (LWBS) rates are key indicators of operational efficiency and patient satisfaction.
• High LWBS rates can negatively impact patient outcomes and hospital performance.
• Disparities in LWBS rates exist across various demographic groups.

Purpose of the Study:

• To evaluate the impact of introducing guest service ambassadors (GSAs) on LWBS rates in an academic ED.
• To determine if GSAs can reduce existing disparities in LWBS rates among different patient populations.
• To assess the effectiveness of a nonclinical staff intervention in improving ED flow and patient care.

Main Methods:

• An observational cohort study was conducted in a Midwestern academic ED from April to December 2022.
• Guest service ambassadors (GSAs) were implemented to assist patients with check-in and manage the waiting room.
• Logistic regression and two-sample proportion tests were used to compare LWBS rates pre- and post-GSA implementation, including subgroup analyses by race, ethnicity, sex, and primary language.

Main Results:

• GSA implementation was associated with a significant reduction in the overall LWBS rate from 3.4% to 2.0%.
• A greater reduction in LWBS was observed for Black, Indigenous, and people of color (BIPOC) patients compared to White patients.
• LWBS rates decreased for both male and female patients, though the reduction for non-English speakers did not reach statistical significance.

Conclusions:

• Guest service ambassadors (GSAs) represent a promising strategy for reducing overall ED LWBS rates.
• GSAs can help mitigate disparities in LWBS rates, particularly for BIPOC and female patient populations.
• Further research is needed to address remaining disparities and optimize GSA implementation for all patient groups.