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

Mohsin, Mohammed; Young, Lis; Ieraci, Sue; Bauman, Adrian

doi:10.1111/j.1742-6723.2005.00774.x

Cited by 40 publications

(55 citation statements)

References 36 publications

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“…It causes decreased compliance with clinical guidelines, decision-making errors through focus on the politics of transfer rather than quality of care, and an increase in the quantity of adverse events. ED overcrowding is also conducive to extensive waiting times that cause patients to leave without being assessed (Holroyd et al, 2004;Diercks et al, 2006;Hendrie et al, 2007;Mohsin et al, 2005).…”

Section: Resultsmentioning

confidence: 98%

Understanding interdepartmental and organizational work in the emergency department: An ethnographic approach

Nugus

Forero

2011

International Emergency Nursing

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Section: Resultsmentioning

confidence: 98%

Understanding interdepartmental and organizational work in the emergency department: An ethnographic approach

Nugus

Forero

2011

International Emergency Nursing

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“…Like other studies, we found that patients who LWBS present with conditions of lower urgency, are more likely to be younger patients, to be male, to have arrived without assisted transport, to have self-referred, to be of indigenous Australian background, to be from non-English-speaking backgrounds, and to have arrived in the evening. 2,[15][16][17] The relationship of LWBS with indigenous status is important. Based on data from the Australian Bureau of Statistics, Victoria has a low level of indigenous population compared to the overall data for Australia; 18 however, the issues contributing to higher risk of LWBS for this patient population will need further exploration to tailor effective interventional strategies.…”

Section: Discussionmentioning

confidence: 99%

“…However, unlike other studies, we found that there was no difference in SES and that those who LWBS were less likely to be of lower SES. 2,16 We used the SEIFA IER and the SEIFA Index of Education and Occupation, whereas Mohsin et al, 16 who found an association with lower SES, used the SEIFA index of relative socioeconomic disadvantage. The SEIFA indices measure at an area level and Data are reported as n (%).…”

Section: Discussionmentioning

confidence: 99%

Patients Who Leave Without Being Seen in Emergency Departments: An Analysis of Predictive Factors and Outcomes

Tropea

Sundararajan

Gorelik

et al. 2012

Academic Emergency Medicine

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Objectives: The objective was to identify predictive factors and outcomes associated with patients who leave emergency departments (EDs) without being seen in Victoria, Australia.Methods: This was a retrospective observational study of Victorian ED patient visits between July 1, 2000, and June 30, 2005, using linked hospital, ED, and death registration data. Index ED visits were identified for patients who left without being seen (LWBS) and for those who completed ED treatment and were discharged home. Statistical analyses included a general description and univariate analysis of patient, ED visit, temporal, and hospital-level factors. Logistic regression models were developed to assess risk factors associated with LWBS status compared to patients who completed treatment, to assess 48 hour re-presentations to ED; 48-hour hospital admissions; and 2-,7-, and 30-day mortality among those who LWBS compared to those who completed treatment. Adjusted odds ratios (ORs) and 99% confidence intervals (CIs) are presented.Results: There were 239,305 LWBS episodes, for 205,500 patients over the 5-year period. Independent factors associated with LWBS patients in comparison to those who completed treatment include patients who are younger (15 to 24 years, OR = 2.46, 99% CI = 2.37 to 2.56), male (OR = 1.07, 99% CI = 1.05 to 1.08), of Australian indigenous background (OR = 1.63, 99% CI = 1.53 to 1.73), of non-English-speaking background (OR = 1.08, 99% CI = 1.06 to 1.10), noncompensable status (OR = 1.73, 99% CI = 1.68 to 1.79), self-referring (OR = 1.46, 99% CI = 1.43 to 1.49), nonassisted arrival mode (OR = 1.35, 99% CI = 1.30 to 1.40), and those with a hospital admission in the 12 months before the ED presentation (OR = 1.53, 99% CI = 1.51 to 1.55). Patients who LWBS had triage categories of lower urgency (nonurgent, OR = 8.21, 99% CI = 8.00 to 8.43), attended during the evening (OR = 1.10, 99% CI = 1.08 to 1.12), on either Sunday (OR = 1.20, 99% CI = 1.18 to 1.23) or Monday (OR = 1.20, 99% CI = 1.17 to 1.23), in winter (OR = 1.14, 99% CI = 1.12 to 1.16), with higher rates occurring in higher volume EDs (OR = 2.20, 99% CI = 2.15 to 2.26). There was no greater risk of mortality for LWBS patients compared to patients who completed treatment. The risk of hospital admission within 48 hours of discharge was lower for LWBS patients (OR = 0.60, 99% CI = 0.58 to 0.62); however, ED re-presentation risk was higher (OR = 1.63, 99% CI = 1.60 to 1.67). Conclusions:Patients who leave EDs in Victoria, Australia, without being seen are at lower risk of hospital admission and at no greater risk of mortality, but are at higher risk of re-presenting to an ED compared to patients who complete treatment and are discharged home.

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“…3 The most common reason for walking out before being seen in EDs in other contexts is dissatisfaction with the waiting time. 23 However, Indigenous patients generally waited a similar time, and often slightly shorter, to be seen as similar non-Indigenous patients. This confirms the findings of the literature review.…”

Section: Indigenous Healthmentioning

confidence: 98%

Accessibility and quality of care received in emergency departments by Aboriginal and Torres Strait Islander people

Thomas¹,

Anderson²,

Kelaher³

2008

Aust. Health Review

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Objectives: To examine the accessibility and quality of care received in emergency departments by Aboriginal and Torres Strait Islander people compared with other Australians. Methods:We examined 2004-05 data from the National Non-admitted Patient Emergency Department Care database from the Northern Territory and Western Australia, the only jurisdictions where Indigenous identification in the database was considered acceptable. Results:In the NT, Indigenous people were 1.7 times as likely to present to an emergency department as non-Indigenous people. Indigenous patients in the NT and WA do not appear to use EDs for "primary care" problems more than nonIndigenous patients. More NT Indigenous patients walked out before being seen or before their treatment was completed. However, Indigenous patients generally waited a similar time, and often slightly shorter, to be seen as similar non-Indigenous patients in WA and the NT. Conclusions:We recommend the regular monitoring of equity in the accessibility and quality of ED care for Indigenous people compared with other Australians. Indigenous identification in the database needs to improve so monitoring of ED However, most Aboriginal and Torres Strait Islander health care policy and research has concentrated on the primary care rather than the hospital sector.2 Most of the limited attention to hospital services has been on admitted patients rather than emergency departments (EDs), the focus of this paper.The Aboriginal and Torres Strait Islander Health Performance Framework 3 reported that Indigenous Australians were twice as likely to have visited an ED or outpatients clinic in the last week as other Australians. In contrast, the same national surveys showed that Indigenous Australians were only 1.1 times as likely as other Australians to have used any health care services. It is not apparent from these results whether Indigenous patients were accessing ED services at appropriately higher rates than other Australians because of their greater morbidity or What is known about the topic? Indigenous people attend emergency departments (EDs) more often than other Australians, wait a similar length of time before being seen, but are more likely to leave before receiving treatment. What does this paper add?The study confirmed what was known, and found that Indigenous patients in the Northern Territory and Western Australia did not appear to use EDs for "primary care" problems more than non-Indigenous patients. What are the implications for practitioners?The study suggests that EDs may be performing more equitably for Indigenous people than other elements of the health system, but Indigenous identification in the database needs to improve so that monitoring of ED performance can extend beyond WA and the NT.

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

Cited by 40 publications

References 36 publications

Understanding interdepartmental and organizational work in the emergency department: An ethnographic approach

Understanding interdepartmental and organizational work in the emergency department: An ethnographic approach

Patients Who Leave Without Being Seen in Emergency Departments: An Analysis of Predictive Factors and Outcomes

Accessibility and quality of care received in emergency departments by Aboriginal and Torres Strait Islander people

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