Improving patient-provider communication to reduce the left-without-being seen (LWBS) rates at a pediatric emergency department.

摘要

The purpose of this action research study was two-fold: to gain an understanding of the primary reasons that parents or guardians who bring their ill child to the emergency department then leave without being seen (LWBS). To leave without being seen describes the situation when patients that present to the emergency department for medical care register, are screened by the triage RN, but subsequently make the decision not to wait to see a physician or other qualified provider to be medically evaluated, and instead leave the premises. The second, parallel purpose of the study was to engage and empower ED staff in a group process of problem solving in order to develop and test possible solutions to lower the LWBS rate. In this effort, motivational interviewing techniques were used to enhance self-efficacy of a volunteer departmental focus group consisting of ED staff and physicians, a hospital administrator, and two guardians of children who had experienced LWBS in the past. This intervention was chosen because staff morale was low due to the frequent dissatisfaction expressed by families of children served by the ED. This dissatisfaction was related to the three major factors identified in the literature known to contribute to the occurrence of LWBS: ED overcrowding, extended wait times, and lack of attention from staff. The ED focus group met 3 times, and low morale was countered successfully by the action researcher-facilitator employing reflective listening techniques in a motivational interviewing coaching model to improve self-efficacy of participants. The group brainstormed 10 possible interventions to try to address the patient family dissatisfiers, and the one selected for testing combined two interventions: placing medical providers (physicians and nurse practitioners) in triage, and having administrative leaders conduct regular rounding in the patient waiting room. After testing these interventions throughout January, 2016, the LWBS experience for the same month in the prior year, 2015, was analyzed by examining hospital records, and a 2.36% improvement in the 2016 LWBS experience was noted. Although this correlational finding was observational in nature, it represented a large number of individual children, and their families, each of whom accessed care in a more efficient, easier, and timelier manner.