586 posters, 8 topics, 23 sessions, 1,077 authors, 622 institutions

ISQua's 40th International Conference 2024

24th - 27th September 2024 | Istanbul, Türkiye

P421

Providing an Equity Lens on Quality Metrics: Evaluation of LWBS in the Emergency Department

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Poster Presenter

Lyndia Hayden

Authors

Yvette Calderon, Lyndia Hayden

Affiliations

Emergency Medicine,Mount Sinai Beth Israel,New York,United States

Part of Topic

Patient Safety & Quality Improvement

Providing an Equity Lens on Quality Metrics: Evaluation of Left Without Being Seen in the Emergency Department
Yvette Calderon*1, Pamela Abner1, Cindy Mei1, Lyndia Hayden1 and Health Equity Data Assessment Hub (HEDA)
Emergency Medicine, Mount Sinai Beth Israel, New York, United States

AIMS:

Place an equity lens toward the evaluation of LWBS patients

Use Provider-in-Triage (PIT) to reduce incidence of LWBS to below 2%

Background

Left Without Being Seen (LWBS): A patient leaving the Emergency Department (ED) prior to a completed medical screening exam is a quality and safety concern and has a financial impact.

•Tends to be non-white race with lower urgency and acuity, and are likely to experience prolonged wait times.

•LWBS is clinically relevant: if patients leave the ED with an undiagnosed and/or untreated medical condition, it may exacerbate outside of the hospital. Routine monitoring of LWBS is necessary.

Hospitals can face penalties if they fail to meet certain quality metrics, such as increased rates of LWBS. The Center for Medicare and Medicaid can reduce reimbursement rates for hospitals that do not meet these standards, having a direct impact on the hospital revenue stream

Methods

Period: Q1-2022 to Q2-2023

•Stratify data by race, ethnicity, language, payors, age and gender.

•Examine modifiers: median arrival to triage, time to provider, and placement in ED room.

•A Provider in Triage (PIT) model was used as an intervention. The PIT model typically involves a physician or advanced practice providers.

•Begin Provider-in-Triage (PIT) during weekdays, then expand to weekends, 10 hours per day.

•Conduct mandatory Unconscious Bias education for faculty & staff.

•Conduct mandatory education for registration staff on best practices to collect patient demographics.

Conclusions

Learned observations:

•Black and African-Americans patients and Medicaid/ Medicare patients had higher incidents of LWBS.

•Implementation of PIT increased arrival to ED room and reduced the volume of LWBS from 2% to 1.7%.

•Examining LWBS patients through an equity lens will allow the ED to identify, understand, and address inequities among patients.

•Hospitals can increase revenue generated from providing care to LWBS patients and meet value-based care metrics for the Center for Medicare and Medicaid Services (CMS).

Future Directions

•Expand LWBS PIT Program to other MSHS Emergency Departments

•Continue education with the registration staff on the importance of collecting patient demographics

Contacts:

Yvette.Calderon@mountsinai.org

HEDA@mountsinai.org