Strategies such as direct bedding where patients are seen and evaluated by a nurse, a registration associate, and a healthcare provider leads to significant reductions in ED wait times, length of stay, and reduces rates of patients leaving without being seen (LWBS
Yousefi and Ferreira (14) introduced an ABM combined with group decision-making technique to improve the performance of an ED considering various key performance indicator including LWBS
, LOS, waiting time, number of deaths, number of wrongly discharged patients and total number of discharged patients.
The model used a left without being seen (LWBS
) regression fit from campus A's historical data for wait times to model a patient's probability of LWBS
The decrease in ambulance diversion hours and decrease in the number of patients that LWBS
led to a greater number of completed ED treatment encounters.
The Mackenzie Valley LWB
has three main functions, namely the issuing of land use permits and water licenses in the unsettled claims area until the balance of the land claims are settled in the Mackenzie Valley, processing transboundary land and water use applications in the Mackenzie Valley, and ensuring consistency in the application of the legislation throughout the Mackenzie Valley.
Figure 7 exhibits the results for the other KPIs including LWBS
, number of patients who were incorrectly discharged and number of patients that received treatment and left the ED.
The average LWBS
rate of the EDs was 2.18% in 2012, while the minimum was 0.2% and the maximum was 14.6%.
Strategic-Related Variable Chanqe Pre Policy Post Policy Difference Change Change Average time from ED 156 minutes 162 minutes +6 minutes (1 %) arrival to dismissal Average time from ED 330 minutes 262 minutes -68 minutes (21 %) arrival to inpatient admission Average time from 216 minutes 103 minutes -113 minutes (52%) inpatient admission decision to transfer to an inpatient care unit Average ED LWBS
rate 1.8% 1.1% -0.7% Average ambulance 11.6% 0.3% -11 diversion rate Hold hours 1,765 hours 679 -1,086 hours (61%) Hold hours are defined as all hours retrospective to disposition for any patient in the ED awaiting inpatient transfer greater than 60 minutes.
After approval by the institutional ethics committee and written consent of the subjects, demographic information of the patients with CTAS 4/5, their complaints on admission, WTs, LOS in ED, LWBS
, total cost and whether they presented to ED again within 72 hours of their discharge were all recorded.
As the volume surged, the hospital realized it needed an automated system to avoid significant wait times and reduce the percentage of patients who left without been seen (LWBS