Emergency department patients who leave before treatment is complete

Title

Emergency department patients who leave before treatment is complete

Creator

Smalley CM; Meldon SW; Simon EL; Muir McKinsey R; Delgado F; Fertel BS

Publisher

Western Journal Of Emergency Medicine

Date

2021
2021-03

Description

Introduction: Emergency department (ED) patients who leave before treatment is complete (LBTC) represent medicolegal risk and lost revenue. We sought to examine LBTC return visits characteristics and potential revenue effects for a large healthcare system. Methods: This retrospective, multicenter study examined all encounters from January 1-December 31, 2019 at 18 EDs. The LBTC patients were divided into left without being seen (LWBS), defined as leaving prior to completed medical screening exam (MSE), and left subsequent to being seen (LSBS), defined as leaving after MSE was complete but before disposition. We recorded 30-day returns by facility type including median return hours, admission rate, and return to index ED. Expected realization rate and potential charges were calculated for each patient visit. Results: During the study period 626,548 ED visits occurred; 20,158 (3.2%) LBTC index encounters occurred, and 6745 (33.5%) returned within 30 days. The majority (41.7%) returned in <24 hours with 76.1% returning in 10 days and 66.4% returning to index ED. Median return time was 43.3 hours, and 23.2% were admitted. Urban community EDs had the highest 30-day return rate (37.8%, 95% confidence interval, 36.41-39.1). Patients categorized as LSBS had longer median return hours (66.0) and higher admission rates (29.8%) than the LWBS cohort. There was a net potential realization rate of $9.5 million to the healthcare system. Conclusion: In our system, LSBS patients had longer return times and higher admission rates than LWBS patients. There was significant potential financial impact for the system. Further studies should examine how healthcare systems can reduce risk and financial impacts of LBTC patients.

Subject

HEALTH facilities; CONFIDENCE intervals; DESCRIPTIVE statistics; MEDICAL cooperation; METROPOLITAN areas; RESEARCH; RETROSPECTIVE studies; PATIENTS; EMERGENCY medical services; LONGITUDINAL method; MEDICAL screening; MEDICAL appointments

Rights

Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).

Format

journalArticle

Search for Full-text

Users with a NEOMED Library login can search for full-text journal articles at the following url: https://libraryguides.neomed.edu/home

Pages

148-155

Issue

2

Volume

22

ISSN

1936-900X

NEOMED College

NEOMED College of Medicine

NEOMED Department

Department of Emergency Medicine

Update Year & Number

April 2021 List

Affiliated Hospital

Cleveland Clinic Akron General Hospital

Citation

Smalley CM; Meldon SW; Simon EL; Muir McKinsey R; Delgado F; Fertel BS, “Emergency department patients who leave before treatment is complete,” NEOMED Bibliography Database, accessed October 27, 2021, https://neomed.omeka.net/items/show/11634.

Social Bookmarking