Tuesday, February 23, 2010

The Unmeasured Lost Revenue of Patients Who Leave Your ED

All hospitals keep close track on the number of patients who leave without treatment from their Emergency Department. I have discussed this in past posts and stated that this number should be well below 1%. If you are in excess of 4%, adding up the lost revenue from these patients over a year's time can be a sizable number. But there are even greater revenue losses occurring that you may not be completely familiar with.

In addition to the patients who come in your ED, register and then walk out frustrated by the wait. There is another group of potential patients who never get that far. I am talking about the patients who come to your emergency department with a relatively minor or perhaps chronic condition and see the backlog that exists in your waiting room. Many of these people will not even bother to sign in. They walk in the door and out again without registering. If you have a relatively large number of left without treatment (LWOT) patients, the number that don't even register is estimated to be another 50% of those you do know about. Now we are talking about some significant lost revenue.

But the numbers don't stop here. Those that walk out of your doors mad because they were not seen in a timely basis (both registered and unregistered) will tell everybody. And you seldom get a second chance. Although I know of one patient who came to our ED, saw the wait and decided to take the 20 mile trip to the next ED. That wait was so much longer that they drove back and got in line at our ED again. This is the exception, not the rule. You must have a system and staffing in place to deal with the surge of patients that you will get from time to time.

Ironically, the patients who leave may not have really not needed your services in the first place. But that does not dampen their enthusiasm to bash your lack of response to their perceived needs. Their disdain for your hospital's clinical abilities will extend well beyond the ED into services that have nothing to do with their condition. Their perception is,"If they couldn't take take care of my minor condition, imagine if I had gone in there with something really serious".

No one has an accurate assessment of the magnitude of lost revenue caused by this type of negative word of mouth campaign. But at Compirion we have experience with the growth in new business that occurs almost automatically when we fix the bottlenecks and improve patient throughput in the ED. One hospital saw a 20% increase in ED patients that were treated and discharged. They also saw a 50% increase in patients who were admitted to the hospital through the ED. This type of increase is unusual, but the potential is there.

How much revenue are you losing by patients walking out of your ED without treatment? Don't be fooled by just focusing on the LWOT numbers. The impact is significantly larger than that.

More on this later.

Mark Brodeur

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