When patients check into the emergency department but leave without being seen — often after waiting for hours — it leaves open the possibility that serious medical conditions go untreated.
It’s a problem medical providers across the country are trying to solve. It even has its own acronym: LWBS (left without being seen). This issue is a significant problem in Bend, where the hospital is often at capacity. At St. Charles Bend, the proportion of patients who left the emergency department without being seen was three times the national average in 2015, according to the Centers for Medicare & Medicaid Services.
Data from the second quarter of this year show that in April, May and June, nearly 5 percent of emergency room visits — 534 out of 10,905 visits total — were among patients who left before being seen. In fact, LWBS was the most common diagnosis code applied to patient visits, above chest pain, which prompted 334 visits. The people who left before being seen by a health care professional comprised 3.4 percent of ER visits during the same time period in 2016, or 351 out of 10,370 ER visits.
Michelle Brenholdt, St. Charles Bend’s director of emergency services and trauma program, said the hospital’s rate was an improved 2.5 percent in August. That’s still above the national average of 2 percent, and hospitals typically strive to get their LWBS rates below 2 percent.
“I’m not happy with our ‘left without being seen’ numbers and that’s been really our big focus in the last couple years, to get those down,” she said.
St. Charles has an emergency department improvement committee that meets monthly and brainstorms ways to bring down the number of patients who leave without being seen, Brenholdt said. The hospital is rolling out changes to how it checks patients in and is trying new strategies for speeding up the process of admitting ER patients who need inpatient care.
Part of the problem is that patients often have to wait in the ER after doctors have determined they need to be admitted because all of the beds on their patient floors are full. For example, on the day Brenholdt spoke with us, she said by 9 a.m., there were eight patients in the hospital’s ER waiting for beds to open up on the medical unit, where all 50 of the beds were full.
If hospitals want to bring their overall LWBS rate to below 2 percent, they need to ensure their less urgent patients — those who wait the longest — do not wait longer than an hour to be seen, according to a 2014 study in the American Journal of Emergency Medicine. Doing so requires looking into why people leave and redesigning operations, the study authors said.
Alcohol-related visits are common
The top three diagnoses in the ER during the second quarter of this year — chest pain, abdominal pain and urinary tract infections — were unchanged from the same time period in 2016. The diagnoses that followed were the usual suspects: fainting, headache and nausea and sepsis.
A surprisingly high number of visits — 208 in total — were directly related to alcohol consumption. Those visits were scattered about in smaller categories, but, if compiled into a single category, alcohol-related diagnoses would be the third most common reason people visit the Bend emergency room. Brenholdt cautioned the actual number is far higher because those numbers don’t include people who sustained sprains, concussions or other injuries related to alcohol use.
Sometimes, the alcohol-related visits are simply people who are intoxicated and need a safe place to sleep it off, Brenholdt said. Those patients generally stay in the ER, where staff keeps an eye on them and sends them home when they’re deemed sober enough. Some patients arrive in serious states of alcohol poisoning, at which point they may require a breathing tube or IV fluids.
Others are in withdrawal, which, if it’s severe enough, can bring seizures. With these patients, Brenholdt said St. Charles will treat their symptoms while also connecting them with alcohol treatment.
“Some people, even if they’re quite ill, just absolutely refuse,” she said.
BestCare Treatment Services, a substance abuse treatment provider, plans to open its Brooks Respite & Recovery Center in Redmond this month, which will have six detox beds. It will also have a 10-bed mental health respite facility.
Deschutes County Health Services plans to open a facility in spring 2018 that initially will offer crisis response, peer support and case management. Once the county gets more funding, it plans to add a sobering station and respite space, each with room for five people.
ER is still busy
Overall the number of patients visiting St. Charles’ emergency room continues to rise. This summer was busier than usual, but Brenholdt said things tend to settle down in the fall and into winter.
Brenholdt said she thinks the proximity of St. Charles’ Immediate Care and Bend Memorial Clinic’s Urgent Care clinics near the Bend hospital divert some patients. And while a lack of access to primary care tends to increase ER demand, she thinks access is improving.
St. Charles Bend admits around 21 percent of the patients who visit its ER, which is high relative to national figures. Brenholdt says that shows that people visiting the ER are those that truly need that level of care.
“People are getting good at going to the right place for care,” she said. •