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Emergency Department Left Without Been Seen Project

Emergency Department Left Without Been Seen Project. ED Unit Leadership Council September 2009. What does LWBS mean?. A patient is classified as LWBS (left without being seen) when they leave the emergency department prior to being seen by a doctor or nurse practitioner.

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Emergency Department Left Without Been Seen Project

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  1. Emergency DepartmentLeft Without Been Seen Project ED Unit Leadership Council September 2009

  2. What does LWBS mean? • A patient is classified as LWBS (left without being seen) when they leave the emergency department prior to being seen by a doctor or nurse practitioner.

  3. How often does this happen? • Currently over 100 patients leave our ED without being seen every month. • Our LWBS rate (the percentage of patients who come to the ED and leave without being seen) is above 4%. This is above the national average.

  4. Why is it a problem that patients leave without being seen? • Leaving without being seen is a potential threat to patient safety. If they do not receive care, they risk their condition becoming worse, or making others sick in the community. • Patients who leave without being seen also expose the hospital to liability concerns, as well as lost revenue.

  5. Who’s leaving? • We analyzed over three hundred charts of LWBS patients and found no consistencies i • Age • Gender or • Triage level • Patients left most often: • In the evening • After waiting over 2 hours • On days when volume is over 100 patients • 35% LEFT AFTER THEY WERE PLACED IN A ROOM!!!!!!

  6. What are we going to do about it? • The Unit Council has chosen three areas to target for this project. They are: • Scripting in triage • Reassessing patients after a two hour wait • Decreasing amount of time it takes to be seen by an MD or CRNP when patients are placed in the treatment area

  7. In the triage office…(when bedside registration is OFF) • Inform the patient that there will be a wait before they are brought to the treatment area. • Though you may not be able to provide an exact wait time, inform the patient there are several patients waiting and encourage them to wait to be seen. Give the patient an overview of what is going on in the ED (#beds, #patients, etc…) • Offer comfort measures if applicable (ex. Ice) • Ask the patient to report to triage nurse if they feel worse or they wish to leave. • Make every effort to encourage the patient to wait.

  8. When the patient has been waiting over two hours… • When a patient’s wait is nearing 2 hours, call the patient back to the triage office. • Ask how they are feeling • Update patient on wait time • Reassess VS if abnormal • Encourage patient to continue to wait • Make sure this is documented in the chart!

  9. In the treatment area… • Assess patients within 30 minutes of placement in a room. • Initiate treatments within practice guidelines if appropriate. • If patient has been waiting over an hour to be seen, or is saying they wish to leave, tell the charge nurse or attending. • Provide patients with an update on their care by rounding every hour.

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