Emergency Department Patients Who Leave Before Treatment Is Complete
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 st...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
eScholarship Publishing, University of California
2020-12-01
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| Series: | Western Journal of Emergency Medicine |
| Online Access: | https://escholarship.org/uc/item/3m29t204 |
| _version_ | 1818959098962509824 |
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| author | Courtney M. Smalley Stephen W. Meldon Erin L. Simon McKinsey R. Muir Fernando Delgado Baruch S. Fertel |
| author_facet | Courtney M. Smalley Stephen W. Meldon Erin L. Simon McKinsey R. Muir Fernando Delgado Baruch S. Fertel |
| author_sort | Courtney M. Smalley |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-12-20T11:36:15Z |
| format | Article |
| id | doaj.art-ce07248fb8ff41cea91ece11da812679 |
| institution | Directory Open Access Journal |
| issn | 1936-9018 |
| language | English |
| last_indexed | 2024-12-20T11:36:15Z |
| publishDate | 2020-12-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Western Journal of Emergency Medicine |
| spelling | doaj.art-ce07248fb8ff41cea91ece11da8126792022-12-21T19:42:06ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-90182020-12-0122210.5811/westjem.2020.11.48427wjem-22-148Emergency Department Patients Who Leave Before Treatment Is CompleteCourtney M. Smalley0Stephen W. Meldon1Erin L. Simon2McKinsey R. Muir3Fernando Delgado4Baruch S. Fertel5Emergency Services Institute, Cleveland Clinic Health System, Cleveland, OhioEmergency Services Institute, Cleveland Clinic Health System, Cleveland, OhioAkron General Medical Center, Department of Emergency Medicine, Akron, OhioEmergency Services Institute, Cleveland Clinic Health System, Cleveland, OhioEmergency Services Institute, Cleveland Clinic Health System, Cleveland, OhioCleveland Clinic Health System, Enterprise Quality and Patient Safety, Cleveland, OhioIntroduction: 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.https://escholarship.org/uc/item/3m29t204 |
| spellingShingle | Courtney M. Smalley Stephen W. Meldon Erin L. Simon McKinsey R. Muir Fernando Delgado Baruch S. Fertel Emergency Department Patients Who Leave Before Treatment Is Complete Western Journal of Emergency Medicine |
| title | Emergency Department Patients Who Leave Before Treatment Is Complete |
| title_full | Emergency Department Patients Who Leave Before Treatment Is Complete |
| title_fullStr | Emergency Department Patients Who Leave Before Treatment Is Complete |
| title_full_unstemmed | Emergency Department Patients Who Leave Before Treatment Is Complete |
| title_short | Emergency Department Patients Who Leave Before Treatment Is Complete |
| title_sort | emergency department patients who leave before treatment is complete |
| url | https://escholarship.org/uc/item/3m29t204 |
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