Why Leave The ED Without Treatment?


Patients go to the ED when sick, in pain, or injured. The patient expects to see a physician promptly and receive compassionate treatment that relieves the symptoms. When that doesn’t happen, frustration builds, and the patient may leave without being seen (LWBS) or against medical advice (AMA). Fortunately, better patient experience can help.

Emergnecy Staffing Solutions Better Patient Experience Means Fewer AMA And LWBS Incidents

Can a better experience make a difference?

Overall, socioeconomic, addiction and co-morbidities factors contribute to AMA discharges. However, a major university study showed that wait time from registration to exam room is a significant factor in LWBS patients. Additionally, another study revealed that wait time could also influence the patient’s perception of providers and quality of care. This supports the concept that better patient experience is essential for many reasons. Consistently, 3 things are named as significant factors in the decision to leave:

  • Long wait time before seeing the physician
  • Poor communication from and between ED staff members
  • Lack of empathy shown from staff

Time slips by

From the time a patient enters the ED, the clock begins ticking. The countdown starts with registration and triage, then placement in an exam room, and finally seeing a physician. Studies show over a 20% increase in patients giving the highest satisfaction rating when the total wait time was 10 minutes versus 60. Efficient processes and possibly utilizing a mid-level professional at triage are some ways wait time has been reduced.

Let’s have a talk

Communication has long been known to be a weak link in the healthcare chain. Improving communication between providers, as well as with patients, is an ongoing challenge. Failure of providers to share important details with other healthcare professionals is very frustrating for patients. Furthermore, when patients don’t understand clear explanations or instructions, the ED experience can again turn negative.

I feel for you

Possibly the most critical factor in positive patient experience is empathy shown by healthcare providers. Patients leaving AMA or without being seen often feel the staff have not shown compassion. The feeling that no one cares or believes the reported symptoms certainly detracts from a positive experience.

The doctor is in

Decreasing patient wait time in the emergency department has a positive impact on patient satisfaction. Having a doctor involved with the initial triage helps reduce wait times and prevent overcrowding, according to a 2016 study. The same study found that creating access to primary care physicians in the emergency room decreases wait time by 19%. Primary care doctors can treat patients that have less urgent illnesses or injuries, increasing the number of patients seen. Increasing the number of patients seen decreases wait time which increases smiles, compliance, and satisfaction scores.

Be our guest

The need for good customer service is not new. What is new is the understanding that customers are everywhere, not just people in a retail store. This means patients in an emergency room are customers as well. Excellent customer service includes treating people with respect and courtesy. Respect and courtesy can help calm a person in crisis. Giving a patient excellent customer service improves the patient’s overall perception of the medical care being given.

Keep the patient, treat the illness

Patients come to the ED for diagnosis and treatment. The thought that a patient might leave without receiving care for life-threatening conditions is disturbing. By decreasing wait times, effectively communicating, and showing empathy, more positive patient experiences can be achieved and walkouts reduced.