A study of patients who leave without notice in an A &amp; E department

Lee, K.M.; Wong, Teresa Yuk‐Hwa; Chan, R. Kimberley; Lau, CK

doi:10.1016/s0965-2302(98)90012-1

Cited by 10 publications

(13 citation statements)

References 10 publications

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“…Although the accuracy of waiting time duration is uncertain, percentages have been described in other studies [17,22,27,29,37,43-45]. Probable reasons could be either patients got tired of waiting, seek advice in another healthcare facility or they felt better and left [15,20,46,47]. …”

Section: Discussionmentioning

confidence: 99%

Missing the boat: odds for the patients who leave ED without being seen

et al. 2013

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BackgroundA patient left without being seen is a well-recognized indicator of Emergency Department overcrowding. The aim of this study was to define the characteristics of LWBS patients, their rates and associated factors from a tertiary care hospital of Pakistan.MethodsA retrospective patient record review was undertaken. All patients presenting to the Aga Khan University Hospital, Karachi, between April and December of the year 2010, were included in the study. Information was collected on age, sex, presenting complaints, ED capacity, month, time, shift, day of the week, and waiting times in the ED. A basic descriptive analysis was made and the rates of LWBS patients were determined among the patient subgroups. Logistic regression analysis was used to assess the risk factors associated with a patient not being seen in the ED.ResultsA total of 38,762 patients visited ED during the study period. Among them 5,086 (13%) patients left without being seen. Percentage of leaving was highest in the night shift (20%). The percentage was twice as high when the ED was on diversion (19.8%) compared to regular periods of operation (9.8%). Mean waiting time before leaving the ED in pediatric patients was 154 minutes while for adults it was 171 minutes. More than 32% of patients had waited for more than 180 minutes before they left without being seen, compared to the patients who were seen in ED. Important predictors for LWBS included; Triage category P4 i.e. walk –in-patients had an OR of 13.62(8.72-21.3), Diversion status, OR 1.49(1.26-1.76), night shift , OR 2.44(1.95-3.05) and Pediatric age, OR 0.57(0.48-0.66).ConclusionsOur study elucidates the LWBS population characteristics and identifies the risk factors for this phenomenon. Targeted interventions should be planned and implemented to decrease the waiting time and alternate services should be provided for high-risk patients (for LWBS) to minimize their number.

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Section: Discussionmentioning

confidence: 99%

Missing the boat: odds for the patients who leave ED without being seen

et al. 2013

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“…[3][4][5][6] Studies in Australia and elsewhere have found that the increase in the use of ED has led to longer waiting times and because of this some patients leave the ED without being seen by a doctor. [7][8][9][10][11][12][13][14][15][16][17][18][19] Patients who leave an ED before receiving medical care are an important group because it is not understood whether clinical outcomes are compromised as a result. 15,16 As long as the potential for adverse outcomes has not been disproven, this group remains important in terms of risk management.…”

Section: Introductionmentioning

confidence: 99%

“…15,16 As long as the potential for adverse outcomes has not been disproven, this group remains important in terms of risk management. [17][18][19] If these patients are shown to have subsequent morbidity as well as being unable to obtain care at sites other than the ED, then Health Services are failing this group of patients. Many patients who sought care from public hospital ED could not identify an alternative setting to see a doctor.…”

Section: Introductionmentioning

confidence: 99%

“…27 USA, 1 site 26 000, adult 2.0 Hobbs et al 13 USA, 1 site, 21 months 133 666, all ages 7.4 Khanna et al . 28 UK, 1 site 3 097 3.3 Kyriacou et al 29 USA, 1 site 826 5.8 Lee et al 18 Hong Kong, 1 site 22 022 0.4 Liao et al 30 Taiwan, 1 site 74 485 0.1 McNamara 31 USA, 1 site 850 3.8 Sainsbury 32 USA, 1 site 28 774, all ages 1.2 Shaw et al . 33 USA, 21 sites 48 000, paediatric 1.6 Stock et al 34 USA, 16 sites 52 778, all ages 3.6 Stock et al 35 USA, 25 sites 92 570, all ages 4.2 Weissberg et al 36 USA Little is known about the characteristics of Australian patients who leave an ED without being seen by a doctor.…”

Section: Introductionmentioning

confidence: 99%

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Factors associated with walkout of patients from New South Wales hospital emergency departments, Australia

Mohsin

Young

Ieraci

et al. 2005

Emerg Medicine Australasia

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After adjusting for triage category (urgency of presentation) and triage time, patients from lower socioeconomic backgrounds and those without private health insurance coverage were more likely to leave ED without treatment. These results have important implications for Health Services. Future strategies aimed at minimizing walkouts from public hospital ED should prioritize and target factors identified in the present study.

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“…The main reason for patients not waiting for medical assessment is prolonged waiting times 1 2 5 8. Internationally DNW rates vary considerable from 0.1% to 15% 2 7 9–12.…”

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confidence: 99%

Did Not Wait Patient Management Strategy (DNW PMS) Study

et al. 2011

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Objectives This study was undertaken to assess the usefulness of senior emergency medicine specialists' review of all 'did not wait' (DNW) patients' triage notes and the recall of at-risk patients. Methods A prospective study of all DNW patients was performed from 1 January to 31 December 2008. Following a daily review of charts of those who failed to wait to be seen, those patients considered to be at risk of adverse outcome were contacted by the liaison team and advised to return. Data were gathered on all DNW patients on the Oracle database and interrogated using the Diver solution.Results 2872 (6.3%) of 45 959 patients did not wait to be seen. 107 (3.7%) were recalled on the basis of senior emergency medicine doctor review of the patients' triage notes. Variables found to be associated with increased likelihood of being recalled included triage category (p<0.001), male sex (p<0.004) and certain clinical presentations. The presenting complaints associated with being recalled were chest pain (p<0.001) and alcohol/drug overdose (p¼0.001). 9.4% of DNW patients required admission following recall. Conclusion The systematic senior doctor review of triage notes led to 3.7% of patients who failed to wait being recalled. 9.4% of those recalled required acute admission. The daily review of DNW patients' triage notes and the recalling of at-risk patients is a valuable addition to our risk management strategy.Did not wait (DNW) patients represent an important subset of the emergency department (ED) population because of their high rates of representation and the potential for adverse outcomes. 1e7 The main reason for patients not waiting for medical assessment is prolonged waiting times. 1 2 5 8 Internationally DNW rates vary considerable from 0.1% to 15%. 2 7 9e12 In a previous study conducted by this group over a 14-week period the DNW rate in the research department was 7.47%.Previous international studies have focused on characterising the varying factors associated with DNW patients. These descriptive studies have found that younger male patients, arriving at weekends and at night with lower acuity problems, are more likely to leave without seeing a doctor. 11e14 A number of researchers have focused on the outcome of DNW patients through phonebased follow-up and mailing after time periods ranging from 24 h to 4 weeks. 3 5 7 12 15e17 While the rates of reported adverse events are low, a large proportion of patients are unaccounted for due to poor response rates and consequently accurate outcomes are unknown. A very limited number of studies have suggested an intervention to address this potentially worrying group of patients. 18e20 On a background of a high DNW rate it was decided to implement a risk assessment and management intervention strategy with the aim of reducing the potential for adverse outcomes. This research was performed to assess the usefulness of the strategy. METHODSA prospective study of all ED DNW patients was performed over a 1-year period between January and December 2008. It took place in a teac...

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A study of patients who leave without notice in an A & E department

Cited by 10 publications

References 10 publications

Missing the boat: odds for the patients who leave ED without being seen

Missing the boat: odds for the patients who leave ED without being seen

Factors associated with walkout of patients from New South Wales hospital emergency departments, Australia

Did Not Wait Patient Management Strategy (DNW PMS) Study

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