{"pk":14007,"title":"Emergency Department Patients Who Leave Before Treatment Is Complete","subtitle":null,"abstract":"Introduction:\n Emergency department (ED) patients who leave before treatment is complete (LBTC) represent medicolegal risk and lost revenue. We sought to examine LBTC return visits characteristics and potential revenue effects for a large healthcare system.\nMethods:\n This retrospective, multicenter study examined all encounters from January 1–December 31, 2019 at 18 EDs. The LBTC patients were divided into left without being seen (LWBS), defined as leaving prior to completed medical screening exam (MSE), and left subsequent to being seen (LSBS), defined as leaving after MSE was complete but before disposition. We recorded 30-day returns by facility type including median return hours, admission rate, and return to index ED. Expected realization rate and potential charges were calculated for each patient visit. \nResults:\n During the study period 626,548 ED visits occurred; 20,158 (3.2%) LBTC index encounters occurred, and 6745 (33.5%) returned within 30 days. The majority (41.7%) returned in <24 hours with 76.1% returning in 10 days and 66.4% returning to index ED. Median return time was 43.3 hours, and 23.2% were admitted. Urban community EDs had the highest 30-day return rate (37.8%, 95% confidence interval, 36.41-39.1). Patients categorized as LSBS had longer median return hours (66.0) and higher admission rates (29.8%) than the LWBS cohort. There was a net potential realization rate of $9.5 million to the healthcare system.\nConclusion:\n In our system, LSBS patients had longer return times and higher admission rates than LWBS patients. There was significant potential financial impact for the system. Further studies should examine how healthcare systems can reduce risk and financial impacts of LBTC patients.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"emergency department"},{"word":"Left without being seen"},{"word":"Left Before Treatment Complete"},{"word":"against medical advice"},{"word":"Eloped"},{"word":"Waiting Room"}],"section":"Health Outcomes","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3m29t204","frozenauthors":[{"first_name":"Courtney","middle_name":"M.","last_name":"Smalley","name_suffix":"","institution":"Emergency Services Institute, Cleveland Clinic Health System, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio","department":"None"},{"first_name":"Stephen","middle_name":"W.","last_name":"Meldon","name_suffix":"","institution":"Emergency Services Institute, Cleveland Clinic Health System, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio","department":"None"},{"first_name":"Erin","middle_name":"L.","last_name":"Simon","name_suffix":"","institution":"Akron General Medical Center, Department of Emergency Medicine, Akron, Ohio; Northeast Ohio Medical University (NEOMED), Rootstown, Ohio","department":"None"},{"first_name":"McKinsey","middle_name":"R.","last_name":"Muir","name_suffix":"","institution":"Emergency Services Institute, Cleveland Clinic Health System, Cleveland, Ohio","department":"None"},{"first_name":"Fernando","middle_name":"","last_name":"Delgado","name_suffix":"","institution":"Emergency Services Institute, Cleveland Clinic Health System, Cleveland, Ohio","department":"None"},{"first_name":"Baruch","middle_name":"S.","last_name":"Fertel","name_suffix":"","institution":"Emergency Services Institute, Cleveland Clinic Health System, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio; Cleveland Clinic Health System, Enterprise Quality and Patient Safety, Cleveland, Ohio","department":"None"}],"date_submitted":"2020-05-27T17:37:34+02:00","date_accepted":"2020-05-27T17:37:34+02:00","date_published":"2021-02-26T21:06:21+01:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/14007/galley/7269/download/"}]}