Left Without Being Seen (LWBS)
LWBS is an emergency department quality metric tracking patients who register but leave before receiving a medical evaluation — representing both a patient safety risk and measurable lost revenue, with a national benchmark target below 2%.
What is LWBS?
LWBS — also called Left Before Treatment Complete (LBTC) or Left Without Treatment (LWOT) — captures patients who register at the ED but depart before a provider evaluates them. The national average LWBS rate ranges from 1.8–2.5%, though high-volume urban EDs may reach 5–8%. The financial impact is substantial: each LWBS patient represents $500–$1,500 in lost ED revenue. For a 60,000-visit ED operating at a 2% LWBS rate, that is 1,200 patients annually — averaging $750 each — totaling roughly $900,000 per year in unrealized revenue. The clinical stakes are equally high: LWBS patients are five times more likely to require hospitalization within 72 hours when they eventually seek care elsewhere, confirming that these are genuinely sick patients, not minor complaints. The primary driver is wait time — strongly correlated with door-to-provider time and ED crowding from boarding admitted patients. The Joint Commission expects EDs to track LWBS as a throughput quality metric. LWBS rates stratified by hour of day, day of week, ESI acuity level, and payer consistently reveal that Medicaid patients LWBS at higher rates than commercially insured patients.
Why It Matters for Healthcare Analytics
LWBS is simultaneously a patient safety indicator, a revenue metric, and a throughput benchmark. Analytically, understanding when and why patients leave — which shifts, which acuity levels, which payer classes — focuses operational improvement on the highest-yield interventions rather than broad process changes that may not address the root cause.
How Vizier Tracks LWBS
Upload your ED registration and departure data, then ask "What is the revenue impact of our LWBS rate by shift and ESI level?" — Vizier calculates LWBS rates by time of day, acuity, and payer, and quantifies the annual revenue recovery opportunity from targeted throughput improvements.