Left Without Being Seen (LWBS) is a healthcare term often used by emergency departments (ED) to designate a patient encounter that ended with the patient leaving the healthcare setting before he/she could be seen by a certified physician. A low LWBS rate is a reflection of how well an ED is achieving its primary objective of being the safety net for its community. Patients lost as LWBS also impact liability as well as hospital revenue.

Build a Winning Team

As with any quality measure in the healthcare setting, having the right people with the right attitude is essential to quality performance. Doctors, nurses, Advance Practice Clinicians (APCs), techs – everyone in the ED, plays a critical role in creating positive outcomes. Building a team that understands the goals and initiatives from the start is important.

Efficient Provider Scheduling

Efficient provider scheduling makes a huge difference in the ED’s LWBS rate. Determine the best scheduling strategy for your ED by evaluating patient acuity, number of providers, average daily census and any other element that would affect scheduling. Another scheduling strategy is to specifically adjust coverage based on the efficiency of individual providers.

Quality Incentives

Once the solid foundation for the team is established, focus can shift to open communication, incentives and expectations for success. At all ApolloMD EM practices, incentivizing providers has worked quite successfully. Providers are compensated based on productivity and the Quality Partner Incentive Program which accounts for a percentage of total compensation.

Competitive Operational Performance

Centralize an approach to accountability and action by focusing on operational performance as a group. Share daily individual provider stats via email and department metrics in a central location. Make providers aware of their achievement compared to the general operational level of the department.

Exceptional Leadership

Behind every successful ED is an exceptional leader. Success as a medical director goes beyond demonstrating exceptional clinical skills, but possessing outstanding leadership skills as well. Medical directors should approach department success by leading their team by example.

Close the Divide

Determine if there is a divide among the providers and identify what is causing it. Areas to evaluate include isolated provider seating vs. open provider seating, putting a provider in triage vs. fixing overarching operational issues. Pinpointing the areas of improvement will define where changes should be made.

Customized EHR

Evaluate the EHR system. Answering questions such as, do tracking boards encourage provider efficiency, what is the ordering process and how is charting approached, help determine where changes need to be made.

Collaborative Work Environment

Foster an open, collaborative work environment. Work together as a department and support other departments. Open communication with the hospitalist team allows for smooth admissions. Get nurse management involved in leadership meetings. Monthly or weekly meetings offer a great opportunity to communicate with everyone in the ED.

Lenoir Memorial Hospital has successfully decreased the LWBS rate over the last five years by implementing some of the strategies mentioned above. Download the full white paper for a comprehensive review of Lenoir’s achievement.

Contact ApolloMD’s Business Development team to see how we can help your ED.

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