Children Who Leave the Emergency Department Without Being Seen: Why Did They Leave and What Would Make Them Stay?

Abstract

RESUMOIntrodução: O abandono de doentes do serviço de urgência pediátrico antes da observação médica constitui um problema multifatorial. Procurámos comparar características sociodemográficas de crianças que abandonaram a urgência e das que não abandonaram, assim como avaliar os motivos, recurso subsequente a cuidados de saúde e outcome clínico. Material e Métodos: Estudo caso-controlo prospetivo de amostra aleatória de crianças que abandonaram a urgência e de controlos pareados durante um período de três meses. Foi realizado um questionário telefónico para recolha de informação relacionada com os motivos para o abandono, outcomes clínicos e opiniões gerais. Material and Methods:This was a prospective case-control study of a random sample of children who left without being seen and their matched controls from an emergency department during a three-month period. We performed a phone questionnaire to obtain information concerning reasons for leaving, patient outcomes and general feedback.Results: During the study period, 18 200 patients presented to the emergency department, of whom 92 (0.5%) left without being seen. Fifty-five (59.8%) completed the questionnaire and there were 82 controls. The most common reasons for leaving were 'excessive waiting time' (92.7%) and 'problem could wait' (21.8%). A significantly higher number of patients who left sought further medical care (78.2% vs 11%) but they did not experience higher levels of unfavourable outcomes. Discussion: The waiting time seems to be the major factor that drives the decision to leave. The fact that parents felt safe in leaving and the low level of adverse outcomes highlights the low-acuity nature of the majority of patients who leave. Conclusion:Reducing the waiting times may be the logical strategic mean to decrease the rates of patients who leave without being seen. However, our data seems to indicate that the concerns surrounding clinical outcome after leaving may be partly unwarranted.

Randomized controlled open-label trial to evaluate prioritization software for the secondary triage of patients in the pediatric emergency department

“…We hypothesize that once a predetermined threshold for the patients in the PED would be reached, Optimum® could suggest the activation of a dedicated fast-track team for prioritized patients. Better management of non-urgent ED attendance visits might also reduce the number of patients who leave the ED without being seen, which is directly linked to the LOS [ 24 , 25 ].…”

The Affordable Care Act and emergency department use by low acuity patients in a US hospital

“…This could falsely decrease the rate of low acuity visits, as non-emergent patients tend to leave without being seen due to inconvenience. [27][28][29][30] Geospatial data was not collected on the patients in the study, limiting our ability to evaluate issues such as urban vs rural, which may have important effects on access to primary care. If insurance access increases as result of the ACA, but availability of primary care providers does not change, ED utilization may remain unchanged.…”

Using Queue Theory and Load-Leveling Principles to Identify a Simple Metric for Resource Planning in a Pediatric Emergency Department

“…Long waiting time for patients in emergency departments (EDs) is a well-recognized international phenomenon. [1][2][3] Increased waiting is associated with decreased patient [4][5][6][7][8] and staff 9 satisfaction, higher left without being seen (LWBS) rates, 10,11 and suboptimal outcomes. [12][13][14] Basic supply and demand calculations suggest that wait times can be ameliorated or eliminated by increasing the capacity of health care services (ie, build more ED rooms and hire more providers); however, these interventions are oftentimes neither financially feasible nor sustainable.…”