Characteristics and outcomes of patients who “did not wait” after attending Perth public hospital emergency departments, 2000–2003

Abstract

Objective: To determine characteristics and outcomes of patients who did not wait to see a doctor in emergency departments (EDs). Design and setting: Population‐based outcome study using probabilistically linked ED and Western Australian death records, with ED records from all seven Perth public hospitals that have EDs from 1 July 2000 to 30 June 2003. Main outcome measures: Rates of “did not wait” (DNW) presentations, overall and for individual hospitals; characteristics of DNW patients; mortality rates among DNW patients at 2, 7 and 30 days. Results: DNW rates varied from 2.6% to 6.3% (average, 4.1%) and were generally lower in tertiary teaching hospitals. DNW patients had conditions of lower urgency, predominantly Australasian Triage Scale category 4 (67.1%) and 5 (23.4%). The DNW rates in these categories were 5.8% and 10.6%, respectively (P < 0.001). Patients referred by health care providers had lower DNW rates (0.5%; P < 0.001). DNW patients were more frequently male (4.4% v 3.8%; P < 0.001), and young to middle‐aged adults (15–44 years; 5.8%; P < 0.001). Patients with a higher than average DNW rate were more likely to arrive by private transport (5.0%; P < 0.001) or with police (5.8%; P < 0.001), re‐present for review (8.6%; P < 0.001) or have social or behavioural problems (7.7%; P < 0.001). Most patients (91.9%) did not wait on only one occasion. The 30‐day mortality rate among DNW patients was significantly lower than for patients seen by a doctor and discharged (0.14 v 0.20%; P = 0.026), and for all patients seen in the ED (1.28%; P < 0.001). Conclusions: Patients who did not wait for medical assessment in Perth EDs had conditions of lower acuity and had lower mortality rates than those who waited for assessment.

Missed Opportunities: Evolution of Patients Leaving without Being Seen or against Medical Advice during a Six-Year Period in a Swiss Tertiary Hospital Emergency Department

“…Our results are also in accordance with previous publications, showing that LWBS patients have a wide range of complaints, with musculoskeletal and gastrointestinal complaints ranked first, and a low acuity level [12, 29, 31]. Unlike other studies, complaints related to wounds are infrequent in our study, possibly reflecting a low rate of stab wounds [31].…”

“…This point is in relation with a higher proportion of low-income and poorly insured patients [6, 15, 33, 38]. Both sets of patients are usually young men without insurance or a sociomedical support; alcohol or drug abuse is frequently also present [17, 19, 20, 29, 36, 38]. Therefore, on a healthcare point of view, the LWBS and LAMA patients should be seen as real “missed care opportunities” for the ED [2, 28].…”

Risk of repeat visits, hospitalisation and death after uncompleted and completed visits to the emergency department: a prospective observation study

“…However, their prognosis in terms of repeat ED visits, hospitalisation and mortality is somewhat unclear due to unsatisfactory response rates or follow-up, small sample sizes, or lack of valid comparison 2 3 13 15. In the present large study the AMA patients had an increased rate of return visits and hospitalisation, but not mortality, compared with patients who completed their visits to the ED, during the 30 days after their initial visit to the ED.…”

“…Patients presenting to the ED who leave without evaluation (those who leave WBS), or those who leave AMA, may be severely ill and at risk of experiencing adverse events 2 3 13 15. However, their prognosis in terms of repeat ED visits, hospitalisation and mortality is somewhat unclear due to unsatisfactory response rates or follow-up, small sample sizes, or lack of valid comparison 2 3 13 15.…”

“…Frequent visits to the ED do indeed predict higher mortality24 25 and greater use of other healthcare services and hospitalisation 26. In previous follow-up studies on patients with uncompleted visits13 or on patients who did not wait15 different definitions of the index visits have been used.…”