Does reduced length of stay decrease the number of emergency department patients who leave without seeing a physician?

Previous studies have suggested that most emergency department (ED) patients who leave without being seen by a physician (LWBS) are nonurgent. Our institution developed a fast-track process to reduce length of stay (LOS) for these patients. The present study was conducted to determine the effect of reducing LOS on the number of ED patients who leave without seeing a physician and the acuity of this subset of ED patients. We retrospectively audited, at a tertiary care teaching hospital, the number of LWBS patients and their triage status over two 1-mo periods. These sampling periods corresponded to immediately before and after implementation of five solutions developed by a continuous quality improvement (CQI) process to facilitate patient flow through the triage and fast-track areas of our ED. Before the CQI process was begun, 2.4% of patients (110/4553) left without being seen in a 1-mo study period. Of these, 82 were nonurgent and 28 were urgent. After implementation of the CQI process, 1.1% of patients (51/4514) left without being seen. Of these, 35 were nonurgent and 16 were urgent. There was a significant decrease in the LWBS proportion after the CQI process was implemented. We conclude that (1) reducing LOS is associated with a decrease in the number of ED patients who leave without seeing a physician and (2) many patients who leave without being seen are classified as urgent at presentation.