Solution: use data analysis to tackle the root cause of the problem
In the post-pandemic era of stretched-thin resources, staffing shortages, and throughput bottlenecks, the problem of patients leaving the ED without being seen (LBWS) has worsened substantially.
LWBS: an Effect
Increasing rates of LWBS are mostly a symptom of systemic problems with patient flow. Crowding in the ED, from inpatient beds at full capacity, increasing behavioral health volumes, higher acuity patients, and shortages of ED providers and nurses all contribute to longer wait times and boarding. And longer wait times mean that more patients leave without being seen. In the current strained healthcare climate, it may well be LWBS rates will not abate until causal problems improve.
The fact that more and more patients are leaving the ED without being treated means greater risk that members of high-risk populations will suffer adverse events. And, for hospitals, it means both lost revenue and greater legal risk under the Emergency Medical Treatment and Active Labor Act if and when patients complain that the hospital could not treat them.
The Big Throughput Picture
LWBS rates vary widely from hospital to hospital. But in any hospital, two key metrics serve as reliable predictors of increasing LWBS rates: the average wait time that elapses between the time patients check in and the time they are seen by a provider (the arrival-to-provider time); and the extent to which, because of inpatient overflow, patients are boarding and waiting for beds or placement at other facilities.
Such data may reveal even bigger problems upstream, to which the AHA draws attention in a report on the delays that hospitals face when trying to discharge patients to more appropriate care settings. In 2022, patients were generally sicker and required more complex post-hospital care than they did in 2019, leading to hospital stays that were 19% longer on average than in 2019 and 24% longer for patients requiring post-acute care.
The Joint Commission, an accreditor of healthcare organizations and programs, regards boarding of patients in the ED as inherently risky and concludes that it should be at most four hours. A JAMA Network research letter observes that boarding “is a key indicator of overwhelmed resources and may be more likely to occur when hospital occupancy exceeds 85% to 90%.”
Small Adjustments, Big Improvements
Although no magic bullet can fix this complicated problem, small adjustments can lead to big improvements.
Effective purpose-built analysis evaluates throughput at many points in the continuum, including some that are not typically inspected. Improving throughput problems potentially caused by many different factors requires carefully targeted interventions. Identifying actionable insights at each patient touchpoint and movement requires the comprehensive, easily accessible data sets in d2i’s Emergency Medicine Performance Analytics.
Reducing LWBS requires tracking the metrics that affect arrival-to-provider time, patient flow, staffing, and resource management. Scheduling can be improved by tracking when patients arrive, tracking acuity, and tracking time increments and activities for each patient service or movement of patients.
Busy emergency departments need focused action plans now to tackle the whirlwind of activity and provide safer care. And data is the most important tool in the EM leader’s toolbox. Explore the power of purpose-built analytics by requesting a demo with one of our domain experts, and learn how our specialty-specific tools can improve performance in your organization.