Proactive program makes low LWOT rate even lower
Staff make every effort to retain patients in ED
When is an LWOT (left without treatment) rate of 1% not good enough? Apparently, when you are the ED managers at Affinity Medical Center, Massilon, OH, campus. An aggressive new program has further reduced that rate by 37%.
The program involves two main components: A proactive effort by staff to prevent any patient from walking away, and individual follow-up calls when they do.
"Our LWOT rate has always been less than 1.5%, and usually less than 1%," says Gregory M. Smith, MD, FACEP, the department's medical director. "From January 2005 through October 2005, we had 147 LWOTs," he reports. However, after the new plan was implemented, that number dropped to 88 for the same period in 2006, while the volume of about 23,500 patients annually stayed roughly the same.
The new program was encouraged by the hospital's CEO, who wanted to diminish LWOTs as much as possible, says Smith. "And as part of customer service and satisfaction, we want to see everyone provided with quality care," he adds.
While the ED doesn't have any glaring problems, the managers and staff members always are looking to improve, says Nancy Eckard, RN, BSN, CEN, director of the ED. "We are in a very tight market, with really high competition among four facilities," she says.
A team effort
The program was put together through a team effort, involving Smith, Eckard, and quality director William Reisinger. Smith, who at the time was training to become medical director, used the opportunity to improve departmental function as part of the scholars program related to that training. While Smith created much of the overall program outline, Eckard determined what data needed to be collected and who had to collect it. She also created the data collection forms. [Editor's note: Two of these forms are available.]
Reisinger undertook the responsibility of tracking the data.
The program works like this: Members of the registration staff are trained to react if patients indicate they are going to leave. They ask the patients if they could please wait for someone to come and talk with them. They subsequently call the department secretary, who contacts a physician or nurse. The physician or nurse goes out and talks to the patients and tries to convince them to stay. "It's not like we tell them, 'We will see you now,' or that they will skip ahead of other patients," says Smith. "We tell them that the ED is busy, but that we want to get everyone back in a timely fashion."
Often, he says, the patient just wants to be heard. If they choose to remain, "We log it down as a prevented LWOT," says Smith. If the patient can't be prevented from leaving, the treating physician will call them back — if possible, that day. "We try to show them we are apologetic and that we care, and we try to get them to come back," Smith says. "We also tell them that if they get sick in the future, we hope they give us another chance."
If the physician cannot reach the patient, they will place up to two additional calls by 11 a.m. the next day. If they don't reach the patient, "we consider it resolved, and it goes in the log," Smith explains.
Two forms used
Eckard developed two forms to help track the program. "The first is a daily tracking record kept at registration; it's a log of anyone who registered but left," she explains. On that form the staff can put a peel-off sticker on with basic demographic information on the patient. The second form is an LWOT patient contact sheet, which includes the triage complaint, patient number, whether an LWOT was able to be prevented, and what occurred with the first, second, or third callback attempts.
There has been no change in patient satisfaction rates since the program began, but that's because Press Ganey scores have been in the 99th percentile for the past several years. In fact, the ED recently received one of the inaugural Summit awards for consistent excellence in patient satisfaction from Press Ganey.
However, Smith has definitely noticed a change in the department. "I worked yesterday; we registered 42 people, we had single coverage, and we did not have one person leave," he reports.
Everyone in the department has bought into the goal of getting patients back as soon as possible, says Smith, and they are well aware that LWOTs are being tracked. "I know that when we're busy, that fact helps me to gear up," he says.
Eckard agrees. "Knowing they're being tracked holds everyone to our commitment not to want people to leave," she says.
If one person leaves, that's one too many, Smith says. "That's dollars walking out the door, as well as potential legal risk," he says.
Sources
For more information on how to keep patients from leaving without being seen, contact:
- Nancy Eckard, RN, BSN, CEN, Director, Emergency Department; and Gregory M. Smith, MD, FACEP, Medical Director, Affinity Medical Center, Massilon (OH) Campus. Phone: (330) 837-6899. Smith's e-mail: [email protected].
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content