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CASE STUDY: From Variability to Reliability – A Left Without Being Seen (LWBS) Success Story

OVERVIEW

A large hospital system noticed an alarming pattern – too many patients were leaving the Emergency Department (ED) without being seen by a clinician. Indicative of system bottlenecks and overcrowding, hospital leadership knew that they could not tackle this issue alone.

Within weeks of partnering with the hospital system spanning over two states, Core Clinical Partners rapidly completed Partner Alignment Assessments, launched targeted action plans, and worked closely with medical leaders to provide the tools necessary to address the high LWBS rates. Over a seven-month period, the percentage of patients leaving the Emergency Department before being seen dramatically decreased from 3.7% to under 1% across all hospitals for the first time in the health system’s history. With patients staying to be seen, revenue capture improved to an annualized estimate of $7 million.

THE CHALLENGE

Serving around 400,000 residents across 25 counties, this hospital system faced unique challenges due to its expansive rural and mountainous footprint, spanning more than 20,000 square miles.

 

At the inception of Core’s contract, the system-wide LWBS rate across the network was 3.7%, equating to nearly 6,000 patients annually leaving the Emergency Department before being seen by a clinician. Leadership knew that swift action needed to be taken as high LWBS rates can lead to delayed diagnosis, compromised patient safety, and lost revenue.

THE Solution

  • Deep Dive: Within two weeks of the start of the contract, Core’s Clinical Optimization Group had completed Partner Alignment Assessments at every Emergency Department within the system’s Based on the results of the assessments, initial targeted action plans were developed, and recommendations were delivered to system and site leadership.
  • Alignment & Collaboration: Core’s Clinical Optimization Group was onsite from day one, partnering closely with ED Nurse Leaders and Medical Directors to align, strategize, and provide tools to address identified areas of improvement. Core continues to provide virtual and onsite elbow-to-elbow support throughout the system.
  • Develop Common Understanding and Language of ED Flow: Core led onsite, interactive educational sessions with Medical Directors and ED Nurse Leaders including tabletop exercises and Lean events, focused on understanding and improving Emergency Department flow.
  • Right Team, Right Time: Demand Capacity Models were built and analyzed for both clinician and nursing staffing. Hours were strategically adjusted to better align staffing with patient demand.

THE RESULTS

After partnering with Core, LWBS rates dropped from 3.7% to 0.9% across all hospitals over a seven-month period. This improvement represents an estimated 4,500 additional patients of the initial 6,000 unseen now receiving care each year. The result was twofold – enhancing access to care in the communities they serve while simultaneously generating approximately $7 million in annual revenue recapture for the health system (based on an average of $1,450 per patient served).


Recently, the system achieved a LWBS rate of 0.6%, the lowest in system history. Moreover, LWBS rates have been maintained below 1% for the three most recent consecutive months.

THE Takeaway

Rooted in partnership and early alignment, the Core Clinical Optimization Group worked with site leadership to reduce the percentage of patients leaving without care by 3.1 percentage points, an 84% reduction. Through a shared understanding and unified approach to ED flow, LWBS rates are under 1% for the first time across all hospitals in the system, improving timely access to care for the communities served. This is The Power of Partnership in action.

Looking for a true partner to optimize your Hospital Medicine or Emergency Medicine programs? Contact us to see how we can help!