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Implementation of a Provider in Triage and Its Effect on Left without Being Seen Rate at a Community Trauma Center

Authors Sember M, Donley C, Eggleston M

Received 6 December 2020

Accepted for publication 9 March 2021

Published 29 March 2021 Volume 2021:13 Pages 137—141


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Hans-Christoph Pape

Maria Sember, Chad Donley, Matthew Eggleston

Department of Emergency Medicine, Mercy Health Youngstown Hospital, Youngstown, OH, USA

Correspondence: Chad Donley
Department of Emergency Medicine, Mercy Health Youngstown Hospital, 1044 Belmont Avenue, Youngstown, OH, 44504, USA
Tel +1 330-480-3667
Fax +1-330-729-7961
Email [email protected]

Introduction: Emergency department (ED) overcrowding is a nationally recognized problem and multiple strategies have been proposed and implemented with varying levels of success. It has caused patients to present to the ED but leave without being seen (LWBS). These patients suffer delayed diagnosis, delayed treatment, and ultimately increased morbidity and mortality. In efforts to decrease the number of patients who leave without being seen, one proposed solution is to place a provider in triage to evaluate these patients at the initial point of contact.
Methods: A retrospective chart review was conducted on patient’s presenting to the Emergency Department from October through January for the years 2013 through 2017. A list of all patient dispositions for each study month was analyzed and compared for the 4 consecutive years with the implementation of an Advanced Practice Provider (APP) in triage.
Results: A total of 2162 patients dispositioned as LWBS during the entire study period of October 2013 through January 2017 were enrolled in the analysis. After implementation of a provider in triage, there was a 39% overall decrease (95% CI 0.005) in patients who left the ED before completion of treatment. There was a 69% reduction (95% CI 0.005) in patients who left before seeing the provider in triage. After seeing the provider, we saw an 83% reduction (95% CI< 0.001) in LWBS. Overall, our initial LWBS rate was found to be 5%, and after implementation of a provider in triage that rate decreased to 1%.
Discussion: The addition of a provider in triage decreased our LWBS rate from 5% to 1%. The addition of a provider in triage also helped identify sick patients in the waiting room and helped facilitate more rapid assessment of ED patients on arrival.

Keywords: LWBS, triage, provider, ED overcrowding, walkouts, LWOTs, PIT

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