15 April 2014

Ways to Improve “Left Before Being Seen” Scores

Hospitals track the number of patients who enter their emergency department but leave before being evaluated and treated (“left before being seen” scores) for effective emergency department efficiency. These scores are used to measure patient satisfaction and overall department quality. For one client, South Georgia Medical Center, administrators started to notice longer wait times in the ED due to increased pressure on the hospital’s capacity. These wait times led to reduced patient satisfaction scores and a “left before being seen” (LBBS) score of 6% - well above the median percentage of 2.6% as reported by the Annals of Emergency Medicine.

This hospital’s executive leadership brought in our Kaizen team for a three-day Lean Process Improvement event to tackle the problem and encourage hospital performance improvement. Our emergency physician services team  worked with front-line Emergency Department stakeholders and created a two-step process to improve LBBS scores and prompt emergency department quality improvement.

  • Organization: We set up color-coded zones to sort patients into sections of high and low acuity. This let us match department resources to patient needs, and we were able to “Fast Track” low-acuity patients to treat and discharge them quickly.
  • Planning for High Volume: During forecasted high-traffic times, we set up a three-member team to evaluate patients as soon as they entered the emergency department. Many low-acuity patients were immediately treated and discharged, while those who required further evaluation were sent to the appropriate color-coded zone.

This new system produced rapid, significant and measurable results:


For more on our approach to Emergency Department management, watch this video from Dr. Tony Andrulonis, our SVP of Emergency Services.