Background: 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.
Objective: To assess a triage intervention's impact on LWBS rates among Emergency Severity Index (ESI) level 2 patients especially at risk for adverse outcomes.
Methods: 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.
Results: 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).
Conclusions: "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.
Keywords: LWBS; difference-in-difference-in-difference; direct bedding; left without being seen; triple diff.
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