Leaving Without Being Seen From the Pediatric Emergency Department: A New Baseline

Brandon Kappy; Kenneth McKinley; James Chamberlain; Gia M Badolato; Robert H Podolsky; Gregory Bond; Theresa Ryan Schultz; Sarah Isbey

doi:10.1016/j.jemermed.2023.05.019

Leaving Without Being Seen From the Pediatric Emergency Department: A New Baseline

J Emerg Med. 2023 Sep;65(3):e237-e249. doi: 10.1016/j.jemermed.2023.05.019. Epub 2023 Jun 10.

Authors

Brandon Kappy¹, Kenneth McKinley², James Chamberlain², Gia M Badolato², Robert H Podolsky³, Gregory Bond², Theresa Ryan Schultz², Sarah Isbey²

Affiliations

¹ Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia. Electronic address: bkappy@childrensnational.org.
² Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia.
³ Division of Biostatistics and Study Methodology, Center for Translational Research, Children's National Hospital, Washington, District of Columbia.

PMID: 37659902
DOI: 10.1016/j.jemermed.2023.05.019

Abstract

Background: Left without being seen (LWBS) rates are an important quality metric for pediatric emergency departments (EDs), with high-acuity LWBS children representing a patient safety risk. Since July 2021, our ED experienced a surge in LWBS after the most stringent COVID-19 quarantine restrictions ended.

Objective: We assessed changes in LWBS rates and examined associations of system factors and patient characteristics with LWBS.

Methods: We performed a retrospective study in a large, urban pediatric ED for all arriving patients, comparing the following three time-periods: before COVID-19 (PRE, January 2018-February 2020), during early COVID-19 (COVID, March 2020-June 2021), and after the emergence of COVID-19 variants and re-emergence of seasonal viruses (POST, July 2021-December 2021). We compared descriptive statistics of daily LWBS rates, patient demographic characteristics, and system characteristics. Negative binomial (system factors) and logistic regression (patient characteristics) models were developed to evaluate the associations between system factors and LWBS, and patient characteristics and LWBS, respectively.

Results: Mean daily LWBS rates changed from 1.8% PRE to 1.4% COVID to 10.7% during POST. Rates increased across every patient demographic and triage level during POST, despite a decrease in daily ED volume compared with PRE. LWBS rates were significantly associated with patients with an Emergency Severity Index score of 2, mean ED census, and staff productivity within multiple periods. Patient characteristics associated with LWBS included lower assigned triage levels and arrival between 8 pm and 4 am.

Conclusions: LWBS rates have shown a large and sustained increase since July 2021, even for high-acuity patients. We identified system factors that may provide opportunities to reduce LWBS. Further work should develop strategies to prevent LWBS in at-risk patients.

Keywords: ED operations; crowding; left without being seen; left without treatment; pediatrics.

MeSH terms

COVID-19* / epidemiology
Child
Emergency Service, Hospital
Humans
Retrospective Studies
SARS-CoV-2

Supplementary concepts

SARS-CoV-2 variants