The following is a summary of “Association between day of arrival, time of arrival, daily volume and the rate of patients that “left without being seen,” published in the May 2023 issue of Emergency Medicine by Chiu, et al.

The left without being seen (LWBS) rate is an important quality indicator for emergency departments (EDs). While previous research focused on patient characteristics associated with LWBS, there needs to be more evidence of the impact of departmental variables. For a study, researchers sought to assess the LWBS rate at a granular level, examining its relationship with the day of the week, hour of arrival, and total patient volume.

A retrospective cohort analysis used data from a single academic center, including 109,983 cases. Patient disposition, day of the week, hour of the day of arrival, and total daily volume were captured. Chi-squared tests assessed the differences in LWBS rates based on arrival variables. Polynomial regression was used to analyze LWBS rates by decile of daily patient volume.

The overall LWBS rate over the two years was 1.82%. There was a significant variation in LWBS rates based on the day of the week and the hour of the day (P < 0.001). LWBS rates ranged from 0.73% on Sundays to 2.45% on Wednesdays for the day of the week and from 0.26% between 8 AM and 9 AM to 3.71% between 10 PM and 11 PM for the hour of the day. As total daily patient volume increased, LWBS rates gradually increased until the 70th percentile, followed by significant exponential growth.

LWBS rates in the ED were influenced by departmental variables and exhibited substantial variability. Higher rates were observed on weekdays and during evening hours. Moreover, LWBS rates surpass 2% when daily registrations reach the 70th percentile, with exponential growth in subsequent deciles. Understanding these effects enables targeted interventions to reduce LWBS rates and improve overall throughput in the ED.

Source: sciencedirect.com/science/article/abs/pii/S0735675723000748