The Most Important Patient is the One You Didn’t See
Healthcare Metrics and Their Human Impact
Healthcare is measured by many metrics to show us how we are doing. While I do understand that as an industry it is vitally important that we measure our quality, healthcare is not like manufacturing. Every time we make a mistake or miss ordering appropriately for our patients, we are impacting people’s lives. I have worked in healthcare for more than twenty-five years and I have made mistakes and been witness to others' mistakes. What I have always understood is that those mistakes not only impact the patient (person) but potentially their entire circle of people who care about them.
Understanding LWBS: Left Without Being Seen
In the emergency department, one of the metrics that we measure and use to judge ourselves by is left without being seen (LWBS). This is a percentage of patients (people) that came into the ED to be seen and treated by the healthcare team but left without being seen or treated.
There are times that the ED can be super busy, and patients (people) may have to wait in the waiting room for a period of time before they are seen by a member of the healthcare team. In some instances, those patients (people) might leave out of frustration. Three percent is the number of patients (people) that is considered the acceptable amount to leave the ED without being seen. I question if that is truly acceptable.
The Emergency Department as the Front Door
The ED is often referred to as the front door of a hospital. A large percentage of patients (people) admitted to the hospital come in through the ED. The side doors are often considered to be surgical services, and if your organization has a labor and delivery area, that is another door.
But the ED is the front door. What your community believes about the ED is often what they believe about your entire organization. If your ED has a reputation for extremely long waits and less-than-welcoming staff, patients (people) might choose to go somewhere else.
A Story of LWBS and Its Impact
The Patient Who Left Without Being Seen
A young man was out working in his yard and was bitten by a snake. He really did not think too much about it, as he had seen many snakes in his yard in the past and never seen anything he thought to be venomous. About two hours later, he noticed that the bite was really starting to swell up and become much more painful.
Reluctantly, even though he was feeling a significant amount of pain, he went to the ED. At the desk, he was dismissed and told to wait without any estimate of how long it might take. Frustrated, he left after over an hour.
Driving home, his symptoms worsened, leading to a car accident. Though the healthcare team later provided life-saving care, the patient remembered the poor treatment he received upon his initial visit. This negative experience tarnished the hospital’s reputation within his community.
The Patient Who Was Seen and Treated
Imagine an alternate scenario: The young man is greeted by a nurse who reassures him, explains the wait times, and regularly updates him. When his symptoms worsen, the nurse reassesses him and ensures he receives timely care.
This positive interaction leaves the patient and his family with a good impression of the hospital. Over time, his family chooses the hospital for other healthcare needs, building loyalty and trust in the organization.
The Ripple Effect of Compassionate Care
The patient who left without being seen cost the hospital its reputation—a resource that takes significant time and effort to rebuild. On the other hand, treating patients with compassion and viewing them as individuals rather than statistics builds trust and fosters long-term relationships with the community.
How to Improve LWBS and Patient-Centered Care
For ideas on how to decrease your LWBS percentage and teach your teams how to put people at the center of all they do, reach out for a consultation.