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...