Maximizing efficiency in emergency care: triple interventions to minimize left without being seen: An observational study

Left without being seen (LWBS) is a quality care metric associated with patient-centered outcomes. The risks affecting LWBS are complex and interventions targeting certain risks have diverse effects. We aimed to use different artificial intelligence and machine learning (AI/ML) algorithms to identify the risks affecting LWBS, implement triple interventions specifically targeted at such risks, and compare daily LWBS rate changes before and after the intervention. This is a retrospective observational study. Single urban Emergency Department (ED) daily throughput data from March 1, 2019, to February 28, 2023, were used for AI/ML model prediction. Model performance including accuracy, recall, precision, F1 score, and area under the receiver operating characteristics (AUC) were reported. The top risks affecting the LWBS were identified using the important function of the AI/ML feature. Triple interventions were implemented. The average daily LWBS rate was compared before (March 1, 2019, to February 28, 2023) and after (June 1, 2023, to May 31, 2024). A total of 1919 daily throughput metrics were analyzed, including 1461 daily metrics before the intervention, 92 daily metrics during the wash period, and 366 daily metrics after the intervention. Using data before the intervention, the Extreme Gradient Boosting (XGBoost) and Random Forest AI/ML algorithms predicted LWBS with a similar favorable performance. The 3 common factors influencing the increased daily LWBS rate were triage-to-bed (wait time), boarding time, and door-to-triage in the ED. Rapid triage, direct bedding, and boarding reduction (triple intervention) were implemented on March 1, 2023. We found 4.82% of daily LWBS before the triple intervention compared to 1.93% of daily LWBS after the triple intervention (P < .001). AI/ML approaches can identify common factors that are highly related to LWBS with favorable performance. Triple interventions targeting these factors can reduce the daily LWBS rate by approximately 60%, indicating the efficiency of the ED operational management.