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
Identifier
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
URL Address
Search for Full-text
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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 April 19, 2024, https://neomed.omeka.net/items/show/11634.