Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia.
Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia.
J Emerg Med. 2023 Sep;65(3):e237-e249. doi: 10.1016/j.jemermed.2023.05.019. Epub 2023 Jun 10.
Left without being seen (LWBS) rates are an important quality metric for pediatric emergency departments (EDs), with high-acuity LWBS children representing a patient safety risk. Since July 2021, our ED experienced a surge in LWBS after the most stringent COVID-19 quarantine restrictions ended.
We assessed changes in LWBS rates and examined associations of system factors and patient characteristics with LWBS.
We performed a retrospective study in a large, urban pediatric ED for all arriving patients, comparing the following three time-periods: before COVID-19 (PRE, January 2018-February 2020), during early COVID-19 (COVID, March 2020-June 2021), and after the emergence of COVID-19 variants and re-emergence of seasonal viruses (POST, July 2021-December 2021). We compared descriptive statistics of daily LWBS rates, patient demographic characteristics, and system characteristics. Negative binomial (system factors) and logistic regression (patient characteristics) models were developed to evaluate the associations between system factors and LWBS, and patient characteristics and LWBS, respectively.
Mean daily LWBS rates changed from 1.8% PRE to 1.4% COVID to 10.7% during POST. Rates increased across every patient demographic and triage level during POST, despite a decrease in daily ED volume compared with PRE. LWBS rates were significantly associated with patients with an Emergency Severity Index score of 2, mean ED census, and staff productivity within multiple periods. Patient characteristics associated with LWBS included lower assigned triage levels and arrival between 8 pm and 4 am.
LWBS rates have shown a large and sustained increase since July 2021, even for high-acuity patients. We identified system factors that may provide opportunities to reduce LWBS. Further work should develop strategies to prevent LWBS in at-risk patients.
左未就诊（LWBS）率是儿科急诊部（ED）的一个重要质量指标，高急症 LWBS 患儿代表患者安全风险。自 2021 年 7 月以来，我们的 ED 在最严格的 COVID-19 隔离限制结束后，LWBS 率急剧上升。
我们评估 LWBS 率的变化，并检查系统因素和患者特征与 LWBS 的关联。
我们对一家大型城市儿科 ED 的所有到达患者进行了回顾性研究，比较了以下三个时间段：COVID-19 前（PRE，2018 年 1 月至 2020 年 2 月）、COVID-19 早期（COVID，2020 年 3 月至 2021 年 6 月）和 COVID-19 变异出现后和季节性病毒再次出现（POST，2021 年 7 月至 2021 年 12 月）。我们比较了每日 LWBS 率、患者人口统计学特征和系统特征的描述性统计数据。使用负二项（系统因素）和逻辑回归（患者特征）模型分别评估系统因素与 LWBS 之间的关联以及患者特征与 LWBS 之间的关联。
平均每日 LWBS 率从 PRE 的 1.8%降至 COVID 的 1.4%，再降至 POST 的 10.7%。尽管与 PRE 相比，ED 日流量减少，但 POST 期间所有患者人口统计学和分诊级别均有所增加。LWBS 率与急诊严重指数评分 2 分、平均 ED 普查和多个时段内员工生产力的患者显著相关。与 LWBS 相关的患者特征包括较低的分诊级别和 8 点至 4 点之间到达。
自 2021 年 7 月以来，LWBS 率持续大幅上升，即使是高危患者也是如此。我们确定了可能减少 LWBS 的系统因素。进一步的工作应该制定策略来防止高危患者的 LWBS。
