Identifying XXXX Door-to-Room Goals to Minimize Left-Without-Being-Seen Rates.

@entity1 @entity341 @entity9855
INTRODUCTION: @entity341 ( @entity341 ) @entity1 in the leave-without-being-seen (LWBS) group risk problems of inefficiency, medical risk, and financial loss. The goal at our hospital is to limit LWBS to <1%. This study's goal was to assess the influence on LWBS associated with prolonging intervals between @entity1 presentation and placement in an exam room (DoorRoom time). This study' @entity9855 aim was to identify DoorRoom cutoffs that maximize likelihood of meeting the LWBS goal (i.e. <1%). METHODS: We conducted the study over one year (8/13-8/14) using operations data for an @entity341 with annual census ~50,000. For each study day, the LWBS endpoint (i.e. was LWBS <1%: "yes or no") and the mean DoorRoom time were recorded. We categorized DoorRoom means by intervals starting with  <=10min and ending at >60min. Multivariate logistic regression was used to assess for DoorRoom cutoffs predicting high LWBS, while adjusting for @entity1 acuity (triage scores and admission %) and operations parameters. We used predictive marginal probability to assess utility of the regression-generated cutoffs. We defined statistical significance at p<0.05 and report odds ratio (OR) and 95% confidence intervals (CI). RESULTS: Univariate results suggested a primary DoorRoom cutoff of 20', to maintain a high likelihood (>85%) of meeting the LWBS goal. A secondary DoorRoom cutoff was indicated at 35', to prevent a precipitous drop-off in likelihood of meeting the LWBS goal, from 61.1% at 35' to 34.4% at 40'. Predictive marginal analysis using multivariate techniques to control for operational and @entity1 -acuity factors confirmed the 20' and 35' cutoffs as significant (p<0.001). Days with DoorRoom between 21-35' were 74% less likely to meet the LWBS goal than days with DoorRoom  <=20' (OR 0.26, 95% CI [0.13-0.53]). Days with DoorRoom >35' were a further 75% less likely to meet the LWBS goal than days with DoorRoom of 21-35' (OR 0.25, 95% CI [0.15-0.41]). CONCLUSION: Operationally useful DoorRoom cutoffs can be identified, which allow for rational establishment of performance goals for the @entity341 attempting to minimize LWBS.
