Reducing “Left without being seen” in a community emergency department: A rapid-cycle change project

Abstract

Background and objective: The COVID-19 pandemic in 2020 increased the volume of patients seeking care in the Emergency Department (ED) for a respiratory crisis. Our community hospital experienced a filling of inpatient beds, leading to an overflow of admitted patients in the ED, where adequate staff (nurses, physicians, radiology, and laboratory staff), equipment, and rooms or places for patients were lacking. Times to obtain procedures that included cardiology, laboratory, and radiology performed and resulted significantly increased. Left without being seen (LWBS) is a challenge faced by EDs across the United States (US) and has become more prevalent since the COVID-19 pandemic. Best practice suggests an LWBS rate of less than 2%, but our hospital experienced an increasing rate of hitting over 5\% in January 2021. To reduce this rate, we implemented multiple rapid-cycle Plan-Do-Check-Act (PDCA) change interventions in triage and throughout the ED.

Implementation/Methods: We implemented several rapid-cycle change interventions with a high-level action plan. These actions included hiring medical/surgical nurses to care for admitted patients awaiting beds, adding additional medical providers, implementing greeters, creating specialty chairs inside a major hospital thoroughfare, opening a 12-bed Admit Care Unit (ACU) adjacent to the ED, and more.

Results: The rate of LWBS decreased from a high of 5.3% in January 2021 to 1.09% in January 2022.

Conclusion/Implications to Practice: Patients in the ED recorded as LWBS are at higher risk for safety and quality transgressions. We continue to work toward excellent patient care by continuing to implement rapid-cycle changes in response to barriers as they arise. More research is needed to expand and rethink the process of ED throughput during pandemics and emergent national crises.