Lorch Alice C, Martinez Maureen, Gardiner Matthew
J Healthc Qual. 2018 Jan/Feb;40(1):e15-e19. doi: 10.1097/JHQ.0000000000000073.
Patients who leave without being seen (LWBS) by a medical provider in emergency care settings are a concern because their urgent complaints remain unaddressed. This study aims to characterize the LWBS population in an ophthalmology-dedicated emergency room and to evaluate an intervention designed to decrease the number of these patients. A program of rounding and patient contact in the waiting room of our emergency room was initiated to this end. A patient database was used retrospectively to review 13,124 charts and collect clinical and demographic data on 71 LWBS patients. The percentage of LWBS patients decreased from 0.74% to 0.33% after the intervention (p = 0.00158). Of the LWBS patients, 27% were seen in an ophthalmology clinic within 2 weeks, and 4% were seen back in the emergency room. Of these patients, 49% had some ophthalmology follow-up after leaving. Among those with follow-up, 14% had concerning pathology. Of all LWBS patients, 63% had a primary care physician. We conclude that frequent rounding in an emergency room waiting room can decrease the number of LWBS patients and as such reduce morbidity. This strategy offers potential to improve healthcare outcomes in emergency settings.
在急诊环境中未接受医疗服务提供者诊治就离开（LWBS）的患者令人担忧，因为他们的紧急诉求仍未得到解决。本研究旨在描述眼科专用急诊室中LWBS患者群体的特征，并评估一项旨在减少这类患者数量的干预措施。为此，我们在急诊室候诊区启动了一项查房和患者接触计划。回顾性地使用患者数据库查阅了13124份病历，并收集了71名LWBS患者的临床和人口统计学数据。干预后，LWBS患者的比例从0.74%降至0.33%（p = 0.00158）。在LWBS患者中，27%在两周内在眼科诊所就诊，4%返回急诊室就诊。在这些患者中，49%在离开后进行了一些眼科随访。在进行随访的患者中，14%有相关病理情况。在所有LWBS患者中，63%有初级保健医生。我们得出结论，在急诊室候诊区频繁查房可以减少LWBS患者的数量，从而降低发病率。这种策略有可能改善急诊环境中的医疗结果。
