Characteristics of First Nations patients who take their own leave from an inner‐city emergency department, 2016–2020

Abstract

Objective: Using a strength-based framework, we aimed to describe and compare First Nations patients who completed care in an ED to those who took their own leave. Methods: Routinely collected adult patient data from a metropolitan ED collected over a 5-year period were analysed. Results: A total of 6446 presentations of First Nations patients occurred from 2016 to 2020, constituting 3% of ED presentations. Of these, 5589 (87%) patients waited to be seen and 857 (13%) took their own leave. Among patients who took their own leave, 624 (73%) left not seen and 233 (27%) left at own risk after starting treatment. Patients who were assigned a triage category of 4-5 were significantly more likely to take their own leave (adjusted odds ratio [OR] 3.17, 95% confidence interval [CI] 2.67-3.77, P < 0.001). Patients were significantly less likely to take their own leave if they were >60 years (adjusted OR 0.69, 95% CI 1.01-1.36, P = 0.014) and had private health insurance (adjusted OR 0.61, 95% CI 0.45-0.84, P < 0.001). Patients were more likely to leave if they were women (adjusted OR 1.17, 95% CI 1.01-1.36, P = 0.04), had an unknown housing status (adjusted OR 1.76, 95% CI 1.44-2.15, P < 0.001), were homeless (adjusted OR 1.50, 95% CI 1.22-1.93, P < 0.001) or had a safety alert (adjusted OR 1.60, 95% CI 1.35-1.90, P < 0.001). Conclusion: A lower triage category is a strong predictor of First Nations patients taking their own leave. It has been documented that First Nations patients are under-triaged. One proposed intervention in the metropolitan setting is to introduce practices which expediate the care of First Nations patients. Further qualitative studies with First Nations patients should be undertaken to determine successful approaches to create equitable access

Evaluation of a pathway to address take own leave events for First Nations peoples presenting for emergency care: The Deadly RED project

“…The primary reason for this appeared to be both due to an increase in presentations and slight increase in acuity and in overall wait time including both the additional 15 min per patient to be seen by a doctor and the ED length of stay (EDLOS) increase of 20% per patient between the two study periods. Wait time is known to be a major factor in TOL from other studies 2 . When examining the two time periods, the workflow changes including reduced treatment spaces due to infection concerns and increased waiting room offloads of higher acuity patients secondary to the arrival of COVID19 in our metropolitan ED made the internal processing of patients more complex and increased the wait time and numbers of waiting room patients between the two time periods.…”

“…Wait time is known to be a major factor in TOL from other studies. 2 When examining the two time periods, the workflow changes including reduced treatment spaces due to infection concerns and increased waiting room offloads of higher acuity patients secondary to the arrival of COVID19 in our metropolitan ED made the internal processing of patients more complex and increased the wait time and numbers of waiting room patients between the two time periods. However, despite this increase in the number of First Nation's TOL events, analysis of the qualitative data revealed a very different narrative behind the results with almost half of the of patients who were recorded in EDIS as TOL reporting in their research yarn that they considered their treatment complete.…”

“…1 Patients are consequently waiting longer, resulting in increased rate of those choosing to 'take own leave' (TOL). 2 This overarching term describes patients that 'did not wait' (DNW) or 'left after treatment commenced' (LATC) and defines a major public health concern. 3 In Australia, Aboriginal and Torres Strait Islander patients (hereby respectfully referred to as First Nations people) are overrepresented in patients that TOL in EDs across all geographical jurisdictions compared to the Correspondence: Dr Michelle Davison, Emergency Department, Sunshine Coast University Hospital, 6 Doherty Street, Birtinya, QLD 4575, Australia.…”

“…This issue is further compounded by prevalent access block and overcrowding 1 . Patients are consequently waiting longer, resulting in increased rate of those choosing to ‘take own leave’ (TOL) 2 . This overarching term describes patients that ‘did not wait’ (DNW) or ‘left after treatment commenced’ (LATC) and defines a major public health concern 3 …”