Emergency Department Left without Being Seen Rates and Staff Perceptions Post-Implementation of a Rapid Medical Evaluation and a Provider in Triage

Increasing emergency department (ED) crowding and wait times lead to higher rates of patients who leave without being seen (LWBS) increasing their morbidity and mortality risk. This quality improvement project evaluated the impact of a rapid medical evaluation (RME) with and without a provider in triage (PIT) on variables that reflect ED crowding. These variables were LWBS rates, door to disposition times by acuity level [defined by emergency severity index (ESI)], and ED length of stay (LOS) by admission and discharge category. Post-RME results demonstrated a statistically significant improvement in door to disposition times for the ESI level 5 or routine patients (p=0.037). No statistically significant differences were identified in other variables of interest post-RME, despite a higher acuity population sample which may demonstrate a beneficial effect of the RME. Post-RME with PIT days were calculated to have statistically significantly longer door to disposition times (p=0.022) than RME with PIT, for ESI level 4 less urgent patients and for overall ED LOS of admitted patients (p=0.023). Additionally, qualitative findings support the overall benefit of the RME, despite mixed preferences between RME with PIT versus nurse protocols, desires for enhanced procedures, and reports of increased stress with the RME workload. Although a direct relationship between the RME and improved throughput in the ED could not be established, benefits of the RME are noted and worthy of additional investigation.