From MedPage Today:
The "left without being seen" (LWBS) metric hangs around the neck of every emergency department (ED). Among the many numbers and metrics that impact our day-to-day work as emergency medicine physicians, few are as important or problematic as LWBS. As one of the Hospital Outpatient Quality metricsopens in a new tab or window (OP-22) from CMS, there are strong financial and administrative incentives to provide a medical screening exam as rapidly as possible. A lower LWBS metric means more revenue and decreased liability for the hospital.
What is measured is what matters. We face many issues as emergency physicians, from increasingly complex patients to poor outpatient follow-up to ED crowding. Unfortunately, screening all patients rapidly prompts behavior that exacerbates these issues. The push to lower the LWBS rate has led to some very odd decisions in how care is allocated in the ED.
At my ED, we will often utilize non-traditional areas for our lowest-acuity patients to move them through and get them "seen." This allows us to rapidly evaluate our least sick patients -- but it means our sickest will often languish in the waiting room, waiting for a bed while we devote staff and resources to the patients with the lowest-acuity complaintsopens in a new tab or window.
If that feels wrong to you, that's because it is.
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