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 $109,500.4 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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