Guest Service Ambassadors Cut Patient Walkout Rates in EDs

TOPLINE:

The inclusion of guest service ambassadors (GSAs) in an emergency department (ED) reduced the rate of patients leaving without being seen, with greater benefits observed among patients from Black, Indigenous, and other non-White racial groups.

METHODOLOGY:

• This study investigated the impact of including GSAs, who serve in nonclinical staff roles, in an academic ED in the United States between April and December 2022.
• GSAs were trained to guide patients through check-in, provide updates, and manage expectations around wait times.
• The GSA program initially operated for 4 h/day during a 2-month pilot period, subsequently expanding to 8.5 h/day to align with peak patient arrival times.
• The primary outcome was the absolute change in the percentage of patients who left without being seen before and after GSA program implementation. A subgroup analysis assessed disparities in care by race, ethnicity, and sex.
• Overall, 9798 patients visited the ED during periods of GSA coverage.

TAKEAWAY:

• The presence of GSAs was associated with a reduction in the percentage of patients who left without being seen — from 3.4% to 2.0% (absolute risk reduction [ARR], 1.4%; P < .001).
• Patients from Black, Indigenous, and other non-White racial groups experienced a greater reduction in left-without-being-seen rates (ARR, 1.8%; 95% CI, 0.39-3.14%) than White patients (ARR, 1.2%; 95% CI, 0.48-1.94%).
• Women showed a larger reduction in left-without-being-seen rates (ARR, 1.7%) than men (ARR, 1.0%).

IN PRACTICE:

“Although some disparities remain, the implementation of guest service ambassadors may have helped reduce disparities in left-without-being-seen rates among males and females and reduced left-without-being-seen rates overall for Black, Indigenous, and people of color patients,” the authors wrote. 

SOURCE:

The study was led by Samuel R. Wing, MD, BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. It was published online on February 5, 2025, in Academic Emergency Medicine. 

LIMITATIONS:

The study had unobservable patient characteristics influencing the propensity to leave without being seen and was underpowered to provide conclusive evidence about differential effects by patient race or ethnicity. The study was conducted in a single-site academic setting, possibly limiting the generalizability of the findings to other healthcare settings. Additionally, the study benefited from an established institutional GSA program, which may not be feasible at other institutions.

DISCLOSURES:

The authors did not disclose any funding information. The authors declared no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.