![]() 6 When examining return characteristics of LWBS patients, many studies have demonstrated that this patient population seeks additional medical care after leaving the ED. 5 LWBS rates have been shown to increase during the night shift and when EDs are on diversion status. 4 Another study in an academic pediatric ED showed that LWBS patients with higher acuity level and increased number of ED visits had high rates of admission on return visits. One recent study in a multi-hospital academic health system demonstrated that LWBS patients tended to have lower-acuity complaints and increased ED utilization. Prior studies have characterized the LWBS population to determine the acuity of complaints, risk of missed diagnosis, return patterns, and admission rates. The EDBA additionally defines the group of AMA and eloped patients together as left subsequent to being seen (LSBS), as follows: “the proportion of patients who leave the ED after evaluation by licensed care provider qualified to complete a medical screening examination and initiation treatment but before the disposition decision by the care provider.” For simplicity in separating these two groups, we will use the terminology LWBS as patients who left without MSE completed, and LSBS as patients who had an MSE completed and ultimately eloped or left AMA. In their current definitions, LWBS is defined as “the proportion of patients who leave the ED before initiation of the medical screening exam (MSE).” 3 In the most current EDBA definitions, the LBTC metric includes patients who LWBS, left against medical advice (AMA), and eloped. We have chosen to use the standardized definitions from the EDBA consensus statement published in 2020. The Fourth Emergency Department Benchmarking Alliance (EDBA) Summit published the most updated definitions of key language and vocabulary that should be used when defining key terminology for regulatory definitions. 2 The national average LWBS is 2%, and many hospitals strive to have an LWBS at or below the national average. “Timely and effective care-Emergency Department (ED) throughput,” OP-22, a metric that tracks LWBS, is one of many ED metrics collected to determine quality. The Hospital Outpatient Quality Reporting Program through the Centers for Medicare and Medicaid Services (CMS) collects pay for quality data, which requires hospitals to submit information on certain metrics to measure patient care outcomes. ![]() Many systems use LBTC or the vernacular left without being seen (LWBS) as a marker for ED performance. Losing these patients prior to visit completion can result in harm for the patient and missed revenue opportunities for the healthcare system. One population of patients directly affected by crowding are those who arrive to the ED for evaluation and ultimately leave before treatment is complete (LBTC). Emergency department (ED) crowding has major implications for a healthcare system. ![]()
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