St. Elizabeth Healthcare Edgewood Emergency Department

Edgewood, Kentucky

A collaborative group in the St. Elizabeth Healthcare Edgewood emergency department agreed that the reduction of patients leaving without being seen — motivated by concerns related to patient safety, patient satisfaction, and missed revenue — was an opportunity for improvement. Prolonged wait times drive ED patient elopement and the risk for certain unseen patients experiencing adverse outcomes. Financially, increased LWBS results in foregone revenue and exposes healthcare organizations to the possibility of preventable morbidity and legal actions.

It was proposed that a new area of the ED be developed to care for patients with Emergency Severity Index scores of four and five. The team altered flow and staffing, and they knew that not all patients needed to be treated on a stretcher. This led to five dedicated treatment rooms directly behind triage and the waiting room, now commonly known as “Physician in Triage” or PIT. Since the ED did not have an immediate bedding policy and treatment spaces had not been routinely available related to boarding, placing a provider at triage was likely to reduce the time from arrival to provider evaluation. As wait times drive elopement, reducing time from arrival to provider evaluation drives reduced LWBS.