National Study of Patient, Visit, and Hospital Characteristics Associated With Leaving an Emergency Department Without Being Seen: Predicting LWBS

Pham, Julius Cuong; Ho, George K.; Hill, Peter; McCarthy, Melissa L.; Pronovost, Peter J.

doi:10.1111/j.1553-2712.2009.00515.x

Cited by 66 publications

(50 citation statements)

References 27 publications

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“…However, even after controlling for the correlation, triage testing continues to have a signi cant, albeit diminished, impact on abandonment, thus supporting Hypothesis 5. This con rms similar results reported in Pham et al (2009). Once the correlation is controlled for, the marginal e ect of triage testing on abandonment is quite similar across ESI levels 2, 3 and 4, ranging from -1.3 percentage points to -1.8 percentage points.…”

Section: 23supporting

confidence: 75%

Waiting Patiently: An Empirical Study of Queue Abandonment in an Emergency Department

2015

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We study queue abandonment from a hospital emergency department. We show that abandonment is not only in uenced by wait time, but also by the queue length and the observable queue ows during the waiting exposure. For example, observing an additional person in the queue or an additional arrival to the queue leads to an increase in abandonment probability equivalent to a fteen minute or nine minute increase in wait time respectively. We also show that patients are sensitive to being "jumped" in the line and that patients respond di erently to people more sick and less sick moving through the system. This customer response to visual queue elements is not currently accounted for in most queuing models. Additionally, to the extent the visual queue information is misleading or does not lead to the desired behavior, managers have an opportunity to intervene by altering what information is available to waiting customers.

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Section: 23supporting

confidence: 75%

Waiting Patiently: An Empirical Study of Queue Abandonment in an Emergency Department

2015

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“…They suggested that this figure of 1.7% be used nationally by ED as a benchmark to evaluate their DNW rate. Using the figures published by Pham et al ,22 given our study's findings and acknowledging demographic variations, if our DNW patient management strategy had been employed in the ED studied over the same time period there might have been approximately 66 600 patient recalls and the possibility of 6240 subsequent admissions annually.…”

Section: Discussionmentioning

confidence: 89%

“…This study conducted in an academic teaching hospital adult ED is one of the first attempting to intervene for this specific group of patients within 24 h after they have left the hospital. A recent study conducted by Pham et al 22 in the USA showed a national DNW rate of 1.7% (1.7 per 100 visits) and a total of 1.8 million patients who left the ED before seeing a doctor. They suggested that this figure of 1.7% be used nationally by ED as a benchmark to evaluate their DNW rate.…”

Section: Discussionmentioning

confidence: 99%

Did Not Wait Patient Management Strategy (DNW PMS) Study

et al. 2011

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Objectives This study was undertaken to assess the usefulness of senior emergency medicine specialists' review of all 'did not wait' (DNW) patients' triage notes and the recall of at-risk patients. Methods A prospective study of all DNW patients was performed from 1 January to 31 December 2008. Following a daily review of charts of those who failed to wait to be seen, those patients considered to be at risk of adverse outcome were contacted by the liaison team and advised to return. Data were gathered on all DNW patients on the Oracle database and interrogated using the Diver solution.Results 2872 (6.3%) of 45 959 patients did not wait to be seen. 107 (3.7%) were recalled on the basis of senior emergency medicine doctor review of the patients' triage notes. Variables found to be associated with increased likelihood of being recalled included triage category (p<0.001), male sex (p<0.004) and certain clinical presentations. The presenting complaints associated with being recalled were chest pain (p<0.001) and alcohol/drug overdose (p¼0.001). 9.4% of DNW patients required admission following recall. Conclusion The systematic senior doctor review of triage notes led to 3.7% of patients who failed to wait being recalled. 9.4% of those recalled required acute admission. The daily review of DNW patients' triage notes and the recalling of at-risk patients is a valuable addition to our risk management strategy.Did not wait (DNW) patients represent an important subset of the emergency department (ED) population because of their high rates of representation and the potential for adverse outcomes. 1e7 The main reason for patients not waiting for medical assessment is prolonged waiting times. 1 2 5 8 Internationally DNW rates vary considerable from 0.1% to 15%. 2 7 9e12 In a previous study conducted by this group over a 14-week period the DNW rate in the research department was 7.47%.Previous international studies have focused on characterising the varying factors associated with DNW patients. These descriptive studies have found that younger male patients, arriving at weekends and at night with lower acuity problems, are more likely to leave without seeing a doctor. 11e14 A number of researchers have focused on the outcome of DNW patients through phonebased follow-up and mailing after time periods ranging from 24 h to 4 weeks. 3 5 7 12 15e17 While the rates of reported adverse events are low, a large proportion of patients are unaccounted for due to poor response rates and consequently accurate outcomes are unknown. A very limited number of studies have suggested an intervention to address this potentially worrying group of patients. 18e20 On a background of a high DNW rate it was decided to implement a risk assessment and management intervention strategy with the aim of reducing the potential for adverse outcomes. This research was performed to assess the usefulness of the strategy. METHODSA prospective study of all ED DNW patients was performed over a 1-year period between January and December 2008. It took place in a teac...

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“…[5][6][7]27,30,43 Parmi les patients avec un code de triage de V, 27,5% (HF) et 34,2% (HD) ont fait un DAPCM. Par contre, la majorité (60%) des cas de DAPCM dans notre étude sont des patients ayant un code de triage de IV.…”

Section: Discussionunclassified

“…1,[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Certains DAPCM peuvent avoir des codes de triage urgents. 14,20 Les facteurs les plus souvent associés au DAPCM sont : l'achalandage de l'urgence, 5,6,[21][22][23][24] le temps d'attente jugé trop long, 4,5,9,10,17,20,[25][26][27][28][29] l'attribution d'un code de triage moins urgent, 5,6,17,20,27,[30][31][32][33] les caractéristiques intrinsèques du médecin de garde, 21,23 un jeune âge, [5][6]…”

Section: Introductionunclassified

Étude des facteurs hospitaliers associés aux départs avant prise en charge médicale à l’urgence d’un centre hospitalier de soins tertiaires

Elazhary

Dolbec

Boucher

et al. 2015

CJEM

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RÉSUMÉObjectifL’objectif de cette étude rétrospective était d’identifier les facteurs associés aux décomptes quotidiens de départs avant prise en charge médicale (DAPCM) dans les deux salles d’urgence du Centre hospitalier universitaire de Sherbrooke, Fleurimont (HF) et Hôtel-Dieu (HD).MéthodeDes données cliniques et démographiques anonymisées, ainsi que des données hospitalières, ont été extraites de la banque de données du Centre Informatisé de Recherche Évaluative en Services et Soins de Santé pour la période du 1er avril 2011 au 30 juin 2012. Les variables étant corrélées au nombre de DAPCM par jour par site lors des analyses univariées ont été retenues pour l’analyse de régression linéaire multivariée.RésultatsLes analyses de régression multivariées démontrent que le nombre de DAPCM par jour diminue pour les deux sites lorsque la durée moyenne de séjour des patients non hospitalisés à l’urgence diminue (HF:b=1,17, p<0,001; HD:b=1,41, p<0,001) et lorsqu’un médecin dédié aux patients ambulatoires est présent (HF:b=-4,35, p<0,001; HD:b=-5,48, p<0,001). De plus, des facteurs reliés à l’achalandage des salles d’urgence et la raison primaire de consultation ont également eu un effet sur le nombre de DAPCM par jour.ConclusionDes efforts devraient être faits afin de diminuer la durée moyenne de séjour des patients non hospitalisés à l’urgence et d’assurer la présence d’un médecin dédié aux patients ambulatoires pour diminuer le nombre de DAPCM.

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National Study of Patient, Visit, and Hospital Characteristics Associated With Leaving an Emergency Department Without Being Seen: Predicting LWBS

Cited by 66 publications

References 27 publications

Waiting Patiently: An Empirical Study of Queue Abandonment in an Emergency Department

Waiting Patiently: An Empirical Study of Queue Abandonment in an Emergency Department

Did Not Wait Patient Management Strategy (DNW PMS) Study

Étude des facteurs hospitaliers associés aux départs avant prise en charge médicale à l’urgence d’un centre hospitalier de soins tertiaires

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