1 December 2014

Strategies for Reducing ED “Left Before Being Seen” (LBBS) Incidence

Though the hope is that insurance expansion will encourage patients to seek care from health resources outside of the emergency department, EDs nationwide continue to see overcrowding. Patients who leave without being seen, typically because of long waits, represent the failure of an emergency care system to provide care to those most in need. In this way, reducing “left before being seen” (LBBS) rates should be at the top of an ED’s list of priorities, as high LBBS rates run in opposition to all dimensions of patient-centric healthcare:

  1. High LBBS rates represent a failure to meet the patient community’s medical needs;
  2. Long wait times and failure to receive care damage patient experience and satisfaction; and
  3. LBBS patients whose conditions worsen after leaving usually require more costly care down the line.

One of Sheridan’s partner hospitals struggled with a higher than acceptable LBBS incidence. Growing demand caused the ED to increasingly operate at full capacity, eventually causing the length of time between patient arrival and evaluation to creep to a level that was causing patient dissatisfaction and an increasing LBBS rate.  To solve this problem, they needed to perform a comprehensive audit of ED operations.

After running a three-day, on-site Kaizen event, the hospital’s executive leadership and clinical stakeholders identified two strategies for processing patients more efficiently.

Triage Color-Coding

First, they deployed a color-coded three zone system in the ED waiting room, grouping patients by high, medium or low acuity ailments. This method of organization enabled optimal matching of department resources with patient needs. Low-acuity patients who required minimal resources were directed to a “fast track” area to minimize their time spent in the ER and expedite discharge, improving their experience and freeing up staff to spend time with more critical patients.

Dedicated Triage Team

The second strategy the ED put in place was that, during times of forecasted high demand, a three-member team—comprised of a mid-level ED provider, an ED nurse and a medical technician—was deployed to the triage area. This new triage team could rapidly evaluate patients as they arrived to determine acuity level and initiate certain treatment protocols. Patients with low-acuity conditions had their issues immediately addressed. Patients with illnesses requiring further evaluation were directed to the appropriate color-coded care zone.

Results

Within 90 days of implementing the process improvements, the hospital reduced LBBS occurrences from six percent to less than one percent. The facility also improved on measurements of ED patient satisfaction.

In the current healthcare landscape, ED success and profitability are dependent on efficient throughput, quality care and patient satisfaction. The color-coded zones and team triage approach, identified through a Kaizen evaluation, helped the hospital lower its LBBS incidence and reach all of these critical success factors.

Click here learn more about how the Kaizen continuous improvement philosophy can increase ED efficiency.