Waiting Room Rounding to Decrease LWBS

Abstract

Problem: Patients who leave the emergency department without being seen (LWBS) by a medical provider have been identified as a safety and liability risk as well as a profit loss. One high volume urban teaching emergency department (ED) in southern California has struggled with a percentage of LWBS well over the benchmark. Objectives: The department implemented waiting room rounding as an evidence based change in an effort to reduce LWBS. A goal was set to reduce LWBS to less than five percent in the month of April after rounding began. Methods: ED technicians assigned to triage round on patients who have been waiting in the waiting room every two hours until they have been moved to a room or discharged from triage. Rounding is tracked on paper with a rounding log. Education was provided to ED technicians and ED registered nurses (RN) with a power point presentation and one-to-one discussions. Results: Overall LWBS dropped to 3.4%, but poor enforcement and lack of accountability resulted in poor compliance with rounding in April. Mid-month, it was decided to reduce rounding activities to one day per week to allow staff an opportunity to become used to the change. For the month of April, 27 patients were rounded on in the waiting area and of those, one LWBS. Conclusion: Rounding activities will continue one day per week until compliance is enough to show whether or not it affects LWBS. Management has promised to step up with enforcement and create accountability for following through with the change