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

ABSTRACT

BACKGROUND Left without being seen (LWBS) rates are an important quality metric for pediatric emergency departments (ED), with high acuity LWBS children representing a patient safety risk. Since 07/2021, our ED experienced a surge in LWBS after the most stringent COVID-19 quarantine restrictions ended. OBJECTIVES 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 three time-periods before COVID (PRE, 01/2018 – 02/2020), during early-COVID (COVID, 03/2020 – 06/2021), and after the emergence of COVID-19 variants and reemergence of seasonal viruses (POST, 07/2021 – 12/2021). We compared descriptive statistics of daily LWBS rates, patient demographics, 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 to PRE. LWBS rates were significantly associated with ESI 2 patients, average ED census, and staff productivity within multiple periods. Patient characteristics associated with LWBS included lower assigned triage levels and arrival between 8PM and 4AM. 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.