Beth Israel Deaconess Medical Center, Department of Emergency Medicine, One Deaconess Road, Boston, MA 02215, USA.
Beth Israel Deaconess Medical Center, Department of Emergency Medicine, One Deaconess Road, Boston, MA 02215, USA.
Am J Emerg Med. 2023 May;67:24-28. doi: 10.1016/j.ajem.2023.02.006. Epub 2023 Feb 8.
Patients' left without being seen (LWBS) rate is used as an emergency department (ED) quality indicator. Prior research has investigated characteristics of these patients, but there are minimal studies assessing the impact of departmental variables. We evaluate the LWBS rate at a granular level, looking at its relationship to day of week, hour of arrival and total patient volume.
Retrospective cohort analysis of 109,983 cases from a single academic center. We captured patient disposition, day of week and hour of day of arrival, and total daily volume. Chi-squared test was performed to determine the difference in LWBS rates based on arrival variables. We ran a polynomial regression for LWBS rates by decile of daily patient volume.
The overall LWBS rate was 1.82% over 2 years. This varied significantly by day of week and hour of day (p < 0.001). Day of week rates ranged from 0.73% on Sunday to 2.45% on Wednesday. Hour of day rates ranged from 0.26% between 8 AM-9 AM, to 3.71% between 10 PM-11 PM. As total daily patient volume increased, LWBS rates gradually increased until the 70th percentile, followed by significant exponential growth afterwards.
LWBS rates are not static measurements, and vary greatly depending on ED circumstances. Weekdays and evenings have significantly higher rates. Additionally, LWBS rates climb above 2% as daily registrations reach the 70th percentile, increasing exponentially at each subsequent decile. Understanding these effects will allow for more effective, targeted interventions to minimize this rate and improve throughput.
未被接诊患者（LWBS）率被用作急诊部（ED）质量指标。先前的研究已经调查了这些患者的特征，但几乎没有研究评估部门变量的影响。我们在更细粒度的层面上评估 LWBS 率，考察其与一周中的某天、到达时间和总患者量的关系。
对单家学术中心的 109983 例病例进行回顾性队列分析。我们捕获了患者的处置情况、到达的周几和时间，以及每天的总患者量。通过卡方检验确定基于到达变量的 LWBS 率差异。我们对 LWBS 率进行了 10 分位数的多项式回归。
两年间总体 LWBS 率为 1.82%。这在周几和时间上差异显著（p<0.001）。周几的 LWBS 率从周日的 0.73%到周三的 2.45%不等。时间的 LWBS 率从 8 点到 9 点的 0.26%，到 10 点到 11 点的 3.71%不等。随着每天患者量的增加，LWBS 率逐渐增加，直到第 70 百分位，然后急剧呈指数增长。
LWBS 率不是静态测量，并且根据 ED 情况有很大的变化。工作日和晚上的比率显著较高。此外，当每日登记量达到第 70 百分位时，LWBS 率超过 2%，并在随后的每个十分位数呈指数增长。了解这些影响将有助于更有效地实施有针对性的干预措施，以尽量减少这种比率并提高吞吐量。
