Reduce Patients
Who Leave
Without Treatment
What is your Emergency Department's
Left without Treatment (LWT) rate? According to 2004 benchmarking data3,
the average ED loses at least 2% of patients—and revenue—because
patients choose to leave before getting treatment.In
an era of declining reimbursement, it's more important than ever that patients
who can pay do so. In fact, keeping just one extra billable patient each
day for a year (who would otherwise leave without treatment) adds up to
$109,5004.
Here are four ways to reduce LWT in your emergency department while also
raising patient satisfaction, and improving both quality and your payer
mix. 1.
Keep patients informed about delays.
The main reason patients leave without treatment is not because
of the wait. It is because they don't know why they are waiting and their
wait is not acknowledged. Patients consistently place "informed about
delays" as one of their highest priorities on ED patient satisfaction
surveys. Try these key words from high performing EDs: "I apologize
for your wait. Our mission is to provide very good/excellent care (use
words from your patient satisfaction survey) to all our patients. I know
Dr. Brown (or nurse name) would be concerned about you (or your child)
if you left and he/she did not get to see you today. Let me find out how
much longer the wait will be. Is there anything I can do to make you more
comfortable in the meantime?" or:
When it appears patients are being
taken out of turn: "Different patients require different kinds
of care. We want all of our patients to get the care that is right for
their condition so some patients are taken to the care area appropriate
for their illness before others. Is there anything I can do for you until
the doctor sees you?"
2. Round
on patients in the reception area.
Use "AIDET" key words (Acknowledge- Introduce-Duration-Explanation-Thank
You) to make a personal connection to patients and provide frequent re-assessment
(which is a standard of the Joint Commission on Accreditation of Healthcare
Organizations). Example: "I'm Gina, the charge nurse for the emergency
department. I wanted to let you know we just had two ambulances come in
with patients who need immediate surgery so it may be another hour. I'm
sorry for the delay, but I want you to know we haven't forgotten you and
we would never put you at risk if we thought you had a life-threatening
emergency. Can I get you anything while you wait?"
3. Use
triage protocols and acute care nursing protocols.
By starting care when the patient is triaged, patients feel they
are being cared for promptly. They will be less likely to leave if their
blood has been drawn or x-rays have been done. They will also be less
anxious and more comfortable. (See sidebar to download Studer Group's
recommended ED triage protocols.)
4.
Track Left without Treatment (LWT) by shift
and hold charge nurses accountable.
At one emergency department, leaders post the LWT rate by shift
and discuss the rates in a coordinator—charge nurse meeting. This fosters
some healthy competition among high performing staff. The result? LWT decreased
50% between July and October 2005 for an additional $288,000 in revenue
during the period. 3
2004 VHA On-Line Survey and Solucient second quarter 2004
4
Assumes an average reimbursement rate of $300 per patient for an ED treat/release
patient.
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