Reduced left-without-being-seen rates and impact on disparities after guest services ambassadors implementation.

IF 3.4 3区 医学 Q1 EMERGENCY MEDICINE
Academic Emergency Medicine Pub Date : 2025-03-01 Epub Date: 2025-02-05 DOI:10.1111/acem.15100
Samuel R Wing, Ciara Barclay-Buchanan, Shawn Arneson, Denise Buckley, Daniel J Hekman, Joshua Gauger, Collin Michels, Jenna Brink, Irene Hurst, Daniel R Rutz, Ryan E Tsuchida
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引用次数: 0

Abstract

Background: The rate of patients who leave without being seen (LWBS) from an emergency department (ED) is a common measurement of quality, operational efficiency, and patient satisfaction. We hypothesized that adding a nonclinical staff role, guest service ambassadors (GSA), to the ED waiting room would decrease LWBS rates and reduce existing differences by race, ethnicity, sex, and primary language for ED patients.

Methods: We conducted an observational cohort study at a quaternary care academic ED in the Midwestern United States with approximately 60,000 annual visits between April and December 2022. GSAs were trained to guide patients and visitors through the check-in process and help manage the waiting room. LWBS rates were compared between pre- and postimplementation periods using logistic regression. Using two-sample proportion tests, subgroup analyses were performed to assess differences according to race, ethnicity, sex, and primary language.

Results: We analyzed 50,507 ED visits including 9798 during periods of GSA coverage. GSA presence was associated with a reduction in LWBS rate from 3.4% to 2.0% (absolute risk reduction [ARR] of 1.4%, χ2 = 17.357, p < 0.001) with an adjusted odds ratio (OR) of 0.65 (95% confidence interval [CI] 0.49-0.85). There was a greater reduction in LWBS for Black, Indigenous, and people of color (BIPOC) patients compared to White patients (BIPOC ARR 1.8%, 95% CI 0.39%-3.14%; White ARR 1.2%, 95% CI 0.48%-1.94%). There was a reduction in LBWS rates for both males and females (female ARR 1.7%, 95% CI 0.80%-2.63%; male ARR 1.0%, 95% CI 0.06%-1.90%). The reduction in LWBS for patients speaking a language other than English and requiring interpreter services did not meet statistical significance (ARR 1.4%, 95% CI -1.04% to 3.85%).

Conclusions: Although some disparities remain, our study suggests that GSAs may provide an effective strategy to reduce the overall LWBS rate and reduce disparities across diverse demographic groups including BIPOC and female patients.

减少了客人服务大使实施后的未见率和对差异的影响。
背景:从急诊科(ED)离开的患者无诊率(LWBS)是衡量质量、操作效率和患者满意度的常用指标。我们假设,在急诊科候诊室增加一个非临床工作人员角色,即客户服务大使(GSA),将降低LWBS发生率,并减少急诊科患者因种族、民族、性别和主要语言而存在的差异。方法:我们在2022年4月至12月期间,在美国中西部的一家四级护理学术急诊科进行了一项观察性队列研究,每年约有60,000次就诊。gsa接受了培训,以指导患者和访客完成登记过程,并帮助管理候诊室。使用逻辑回归比较实施前后的LWBS率。采用双样本比例检验,进行亚组分析,以评估种族、民族、性别和主要语言的差异。结果:我们分析了50,507例ED就诊,其中9798例在GSA覆盖期间。GSA的存在与LWBS发生率从3.4%降至2.0%相关(绝对风险降低[ARR]为1.4%,χ2 = 17.357, p)。结论:尽管存在一些差异,但我们的研究表明,GSA可能提供了一种有效的策略,可以降低总体LWBS发生率,并缩小包括BIPOC和女性患者在内的不同人口统计学群体之间的差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Academic Emergency Medicine
Academic Emergency Medicine 医学-急救医学
CiteScore
7.60
自引率
6.80%
发文量
207
审稿时长
3-8 weeks
期刊介绍: Academic Emergency Medicine (AEM) is the official monthly publication of the Society for Academic Emergency Medicine (SAEM) and publishes information relevant to the practice, educational advancements, and investigation of emergency medicine. It is the second-largest peer-reviewed scientific journal in the specialty of emergency medicine. The goal of AEM is to advance the science, education, and clinical practice of emergency medicine, to serve as a voice for the academic emergency medicine community, and to promote SAEM''s goals and objectives. Members and non-members worldwide depend on this journal for translational medicine relevant to emergency medicine, as well as for clinical news, case studies and more. Each issue contains information relevant to the research, educational advancements, and practice in emergency medicine. Subject matter is diverse, including preclinical studies, clinical topics, health policy, and educational methods. The research of SAEM members contributes significantly to the scientific content and development of the journal.
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