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Does reduced length of stay decrease the number of emergency department patients who leave without seeing a
C M Fernandes1, A Price, J M Christenson
1Department of Emergency Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada.
The Journal of Emergency Medicine
|May 1, 1997
Summary
Implementing a fast-track process significantly reduced the number of emergency department (ED) patients leaving without being seen (LWBS). This improvement in patient flow also highlighted that urgent cases are a significant portion of LWBS patients.
Area of Science:
- Emergency Medicine
- Healthcare Management
- Quality Improvement
Background:
- Previous research indicated most emergency department (ED) patients leaving without being seen (LWBS) were nonurgent.
- High patient volumes and extended lengths of stay (LOS) are common challenges in emergency departments.
Purpose of the Study:
- To evaluate the impact of a fast-track process on reducing the number of LWBS patients.
- To assess the acuity of patients who leave the ED without being seen after implementing LOS reduction strategies.
Main Methods:
- A retrospective audit was conducted at a tertiary care teaching hospital.
- Data on LWBS patients and their triage status were collected for two 1-month periods, before and after implementing a continuous quality improvement (CQI) process.
- The CQI process focused on improving patient flow through triage and fast-track areas.
Main Results:
- The proportion of LWBS patients decreased significantly from 2.4% (110/4553) before the CQI process to 1.1% (51/4514) after its implementation.
- Before the intervention, 82 LWBS patients were nonurgent and 28 were urgent.
- After the intervention, 35 LWBS patients were nonurgent and 16 were urgent.
Conclusions:
- Reducing length of stay (LOS) in the ED is associated with a decrease in the number of patients leaving without being seen (LWBS).
- A notable proportion of patients who leave the ED without being seen are classified as urgent, challenging previous assumptions.
- Continuous quality improvement (CQI) initiatives can effectively enhance patient flow and reduce LWBS rates in emergency departments.