Is there equity in emergency medical care? Waiting times and walk-outs in South Western Sydney hospital emergency departments

Mohsin, Mohammed; Bauman, Adrian; Ieraci, Sue

doi:10.1071/ah980133

Cited by 23 publications

(33 citation statements)

References 15 publications

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“…Sex and postcode did not predict waiting times. Hence we found no evidence that the patient characteristics identified in the Australian study 9 were important predictors of prolonged waiting times in the UK. The most important factors affecting waiting time were related to time of presentation.…”

Section: Discussioncontrasting

confidence: 58%

Who waits longest in the emergency department and who leaves without being seen?

Goodacre

Webster²

2005

Emergency Medicine Journal

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Objectives: To determine which patient characteristics are associated with prolonged waiting times in the emergency department and which characteristics are associated with an increased risk of leaving without being seen. Methods: Multivariate analysis of routine data collected at the Northern General Hospital, Sheffield between 1 January and 31 December 2001. Patient age, sex, triage priority, postcode, initiator of attendance, mode of arrival, time, day, and month of presentation were examined as potential predictors of waiting time and risk of leaving without being seen. Results: Waiting time data for 71 331 patients were analysed, along with a further 5512 patients who left without being seen. Older patients and those with lower triage priority had longer waiting times, while ambulance borne patients had slightly shorter waiting times. Sex, source of referral, and postcode did not predict waiting times. The most powerful predictors of waiting time related to time of presentation, with longer waits being associated with presentation at night, on Mondays or Sundays, and during autumn months. Patients who left without being seen were more likely to be younger, male, lower triage priority, non-ambulance borne, self referred, and presenting at the times when waiting times were longest. Conclusion: Time of presentation, rather than individual patient characteristics, seem to be the most powerful predictors of waiting time. This suggests that concerns about inequity of waiting times should be addressed by reorganisation of staff duty rosters. P rolonged waiting times for patients in the emergency department are associated with reduced patient satisfaction 1 and an increased risk of leaving without being seen.2 This in turn is associated with high rates of representation and poorer health outcomes. 2 Waiting times have been increasing in the United Kingdom 3 and have been identified as a priority area by the UK Department of Health.4 5 As a result a number of initiatives have been introduced in an attempt to tackle this problem. 6 7 It is clearly important to reduce waiting times, yet it is highly unlikely that current initiatives will abolish waits completely. It is therefore also important that waiting times are equitable for individual patients. That is, differences in individual patients' waiting times should be, as far as possible, related only to clinical need. Waiting times act as a barrier to access to health care, and equity of access to health care is an important goal for the NHS. Data from Australia 9 suggest that waiting times are not equitable and that women, non-English speaking patients, self referred patients, or patients with a lower socioeconomic status are more likely to wait longer. To our knowledge, no study has yet attempted to discover if these findings are reproduced in the UK. The aim of this study was therefore to identify factors predicting prolonged waiting times for patients attending our emergency department and factors predicting which patients are most likely to leave without bein...

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Section: Discussioncontrasting

confidence: 58%

Who waits longest in the emergency department and who leaves without being seen?

Goodacre

Webster²

2005

Emergency Medicine Journal

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“…Studies in other countries including Canada, UK and Australia showed WBS rates from 4.5% to 8.2% 5–7. The WBS patients have lower acuity, are younger and more often male than other patients in the ED 2–4 8. The WBS rates have been found to be related to ED overcrowding2 9 and to the overall length of time patients stay in the ED before leaving 2 3.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2012

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“…3 6-8 16 Most of these previous studies were limited to examining the association of sociodemographic characteristics and urgency of presentation with the walkout of patients from emergency departments. [6][7][8] However, none of this research had followed up patients after they left emergency departments without treatment. This paper explores the characteristics of patients who left an emergency department without being seen by a doctor at a tertiary principal referral hospital and follows-up the walkout patients after 7 days by telephone, to identify the reason for walkout, and health services utilisation after the emergency department visit.…”

mentioning

confidence: 99%

A population follow-up study of patients who left an emergency department without being seen by a medical officer

Mohsin

Forero

Ieraci

et al. 2007

Emergency Medicine Journal

115

113

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Objectives: To describe the population of emergency department patients who leave without being seen by a medical officer, to investigate the circumstances of their visit and to ascertain whether they subsequently receive alternative medical care. Methods: A follow-up study was conducted of patients who were initially triaged, but left without being seen by a medical officer between July 2003 and October 2003 in a tertiary referral hospital emergency department in Sydney, Australia. Emergency Department Information System data were reviewed for population demographics, presenting complaints and acuity rating of patients. Follow-up telephone interviews were conducted within 7 days after the patient left the emergency department. Results: During the study period, 8.6% (1272 of 14 741) of the emergency department patients left without seeing a doctor and 35.9% (457 of 1272) of these patients who walks out were contacted for follow-up. The results from bivariate and multivariate analyses showed that walkout rates significantly varied by sociodemographic and clinical characteristics of the patients. Young patients aged 0-29 years, and those with longer waiting time for triage and triaged as ''less urgent'' were more likely to walk out than others. Overcrowding in the emergency department had a significant association with walkout of patients. Prolonged waiting time was the most common reason for leaving emergency departments without being seen by a doctor. Only 12.7% (58 of 457) of the walkout patients revisited emergency departments within 7 days of their departure and of those who were subsequently admitted following their return to hospital accounted for 5.0% (23 of 457). Of the follow-up patients, 39.4% felt angry about their emergency department experiences. Conclusions: The number of patients who leave an emergency department without seeing a doctor is strongly correlated with waiting time for medical review. Achieving shorter emergency department waiting times is central to reducing the numbers of people leaving without being seen. The rate of patients who leave without being seen is also strongly correlated with triage category. These findings highlight the importance of accurate triaging, as this clearly influences waiting time. It is also likely that there are patients who benefit from the reassurance of the triage assessment, and therefore feel less urgency for medical review. These may be cases where immediate medical review is not essential. This area should be further explored. These results are important for planning and staffing health services. Decision makers should identify and target factors to minimise walkouts from public hospital emergency departments.A substantial number of patients who attend public hospital emergency departments for emergency medical care are triaged, then leave without being seen (LWBS) by a doctor.

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Is there equity in emergency medical care? Waiting times and walk-outs in South Western Sydney hospital emergency departments

Abstract: Abstract

Cited by 23 publications

References 15 publications

Who waits longest in the emergency department and who leaves without being seen?

Who waits longest in the emergency department and who leaves without being seen?

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

A population follow-up study of patients who left an emergency department without being seen by a medical officer

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