155 Implementation of a Direct Bedding Strategy Results in a Rapid and Sustained Reduction in Left Without Being Seen

We sought to improve left without being seen in our high volume, high-acuity, tertiary care, urban, trauma center. Prior to our study period, our left without being seen rate was 4.4%. We implemented a direct bedding strategy. Known colloquially as pull-to-full, we utilized this strategy successfully to reduce our rates to under 1% We utilized a retrospective before and after observational model. This was a quality improvement project and did not require institutional review board approval. With the hiring of a clinical documentation specialist, we tracked multiple metrics. These included daily census numbers, admission rates, door-to-provider times, door-to-room times, average boarding times, and door-to-disposition times. These data were collected and shared with emergency department staff daily. Reports were also shared at organizational quality meetings. Simultaneously, we implemented the direct bedding initiative; pull-to-full. All emergency department staff were given education commensurate to their jobs and functions. In order to accommodate higher numbers of patients in our department and expedite movement from the reception area to care spaces, all patient care spaces were clearly designated and labeled. These spaces were mapped and placed into our electronic medical record. The total number of patient care spaces increased dramatically. Although our department has 67 physical rooms, the reorganization resulted in over 115 designated patient care spots. Pull-to-full began in September of 2015. At that time, our left without being seen rate was 4.4%. We were able to drop left without being seen rates to below 1%. Pull-to-full resulted in an immediate and sustained decline in left without being seen rates. Our volume and acuity remained stable. Initially, there were significant barriers, which included decreased staff work satisfaction, an increase in nursing and physician patient loads, as well as hospital physical plant changes. Regardless, we demonstrated a continued and sustained improvement trend for left without being seen each subsequent year compared to prior to pull-to-full, (t-test p value <0.01). Currently our left without being seen rates are less than 1% [Figure 1]