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A Look at Patients’ Willingness to Wait for ED Care

A Look at Patients’ Willingness to Wait for ED Care

As the number of patients seeking emergency care in the United States continues to grow, so too has ED crowding and boarding. “Throughout the country, there has been an increase in volume of ED patients and boarding of patients waiting to be admitted to the hospital,” says Sanober Shaikh Syed, MD. “This can prolong wait times for many patients seeking emergency care. EDs nationwide are struggling to balance demand with capacity.” Prior studies have shown that the longer patients wait, the more likely they are to leave without being seen (LWBS). These analyses have also revealed that a significant portion of patients who LWBS are classified as needing emergent or urgent medical care. A key question that remains unanswered is how long patients are willing to wait before they choose to LWBS by a healthcare provider. Waiting Thresholds Before Leaving the ED Dr. Syed and colleagues conducted a study evaluating patients’ threshold for waiting before they choose to leave the ED waiting room without being seen by an ED provider. The study, published in the Western Journal of Emergency Medicine, also looked at whether willingness to wait was influenced by other factors, including illness severity, age, and insurance status. “Knowing the limits to which patients will wait may be useful in tailoring strategies to reduce wait times,” Dr. Syed says.   In the study, patients who were triaged were given a questionnaire to determine how long they would wait for medical care. The authors also assessed data on age, gender, race, insurance status, and triage acuity level. More than half of the 340 patients who answered the survey were...

Addressing ED Crowding With Patient Flow Strategies

The number of ED visits has grown by 25% in the past decade, but the number of hospital EDs and inpatient beds has declined during that same time-frame, resulting in crowded conditions nationwide. Nearly half of EDs are operating at or above capacity, and few consistently achieve recommended wait times for all ED patients. The impact of ED crowding has been profound, leading to poor quality care, increased mortality rates, and lower patient and staff satisfaction. Major Findings on Improving Patient Flow In an effort to strengthen the evidence base for patient flow improvement strategies, Megan C. McHugh, PhD, and colleagues evaluated the efforts of five hospitals that participated in a collaborative aimed at improving patient flow and reducing ED crowding. Results were published in the September 13, 2011 Journal for Healthcare Quality. Participating hospitals implemented seven improvement strategies over 18 months as part of the collaborative. By the end of the study, four of the five hospitals had at least one fully implemented improvement strategy and had experienced modest improvements in patient flow, including reduced length of stay and fewer patients left without being seen. The improvement strategies and their impact varied considerably in the study, according to Dr. McHugh. “Several factors appeared to influence the impact of strategies, including ability to overcome implementation challenges, the timing of implementation, and the type of strategy selected. We also found that the staff time and expenses involved in the adoption of the ED strategies were highly variable.” Few studies have considered time and expenses associated with implementing patient flow strategies. In Dr. McHugh’s study, time spent planning and implementing the...

A New Look at Leaving Without Being Seen in EDs

A decrease in access to EDs throughout the United States has strained the healthcare system significantly. When patients leave the ED without being seen, the emergency care delivery system has failed to provide care to individuals who are in greatest need. Studies have shown that left without being seen (LWBS) visits are a marker of ED crowding and have been associated with longer waits. “The number of LWBS visits has increased dramatically in the past 15 years,” says Renee Y. Hsia, MD, MSc. “This is a reflection of mounting strains on the U.S. emergency care system.” Regardless of the cause—be it longer wait times, increased visits, or decreased supply—patients who leave the ED without being seen signal that access-to-care issues are prevalent. “Previous studies examining LWBS have provided data on patient- level and operational determinants at single hospitals,” explains Dr. Hsia. “There is a need, however, to broaden the scope of what is known about LWBS from a larger perspective rather than in a single-hospital setting.” Little is known about variation in the amount of LWBS or about hospital-level determinants. Contemporary attempts to study LWBS have been limited by the scarcity of data reporting it. Due to a lack of information, the ability of policymakers to understand the effect of crowding on vulnerable communities and to design system-level interventions to improve access to emergency care has been hindered. New Leaving Without Being Seen Data A study published in the July 2011 Annals of Emergency Medicine performed a cross-sectional analysis of 262 acute-care hospitals involving more than 9 million ED visits to hospitals in California that operated an ED in...
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