Patients who leave the emergency department without being seen by a physician: a control-matched study

Abstract

Objective: To describe the socio-demographic characteristics and clinical outcomes of patients who leave the emergency department (ED) without being seen by a physician. Methods: This 3-month prospective study was conducted at a downtown Toronto teaching hospital. Patients who left the ED without being seen (LWBS) were matched with controls based on registration time and triage level. Subjects and controls were interviewed by telephone within 1 week after leaving the ED. Results: During the study period, 386 (3.57%) of 10 808 ED patients left without being seen. Onethird of these had no fixed address or no telephone, and only 92 (23.8%) consented to a telephone interview. They cited excessive wait time as the most common reason for leaving the ED (in 36.7% of cases). Despite leaving the ED without being seen, they were no more likely than those in the control group to seek follow-up medical attention (70 % in both groups). Among those from both groups who did seek follow-up, the LWBS patients were more likely to do so the same day or the day after leaving the ED. The LWBS patients often lacked a regular physician (39.1% v. 21.7%; p = 0.01) and were more likely to attend an ED or urgent care clinic (34.8% v. 12.0%; p < 0.001). Controls were more likely to follow up with a family physician (37.0% v. 23.9%; p = 0.06). The LWBS and control groups did not differ in subjective health status at 48 hours after leaving the ED, nor in subsequent re-investigation in hospital. Conclusions: Patients who leave the ED without being seen have different socio-demographic features, methods of accessing the health care system, affiliations and expectations than the general ED population. They are often socially disenfranchised, with limited access to traditional primary care. These patients are generally low acuity, but they are at risk of important and avoidable adverse outcomes. RÉSUMÉObjectif : Décrire les caractéristiques sociodémographiques et les résultats cliniques de patients qui quittent le département d'urgence sans avoir été vus par un médecin. Méthodes : Cette étude prospective d'une durée de trois mois fut menée dans un hôpital universitaire du centre-ville de Toronto. Les patients ayant quitté l'urgence sans avoir été vus furent appariés à des témoins en tenant compte de l'heure d'inscription et du niveau de triage assigné. Les

Unfavourable outcome for children leaving the emergency department without being seen by a physician

“…The absence of death or suicide attempts among the study participants is concordant with a literature review revealing only one case of suicide attempt in a prospective study of adult patients who LWBS. 19 Finally, our results are in agreement with a 20 We used a broad definition of an unfavourable outcome, including children who only needed an intravenous access or a delayed casting. Many unfavourable outcomes were more of a delay in treatment and diagnosis as opposed to an adverse event per se.…”

Impact of Family Medicine Resident Physicians on Emergency Department Wait Times and Patients Leaving Without Being Seen

“…9,10 Patients who leave the ED without being seen are equally likely as those who were assessed and treated to seek follow-up care. 11 Our study found no difference in T 1 or total LOS between PGY-1 and PGY-2 residents. The family medicine residency program in Canada is two years long.…”

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

“…1,14,21,[23][24][25] These data are concerning because the patients who tend to LWBS are more likely to lack access to alternative primary care and be more at risk for adverse events. 3,[24][25][26] This population may be using the ED as a source of primary care, given the finding that most LWBS visits are of low acuity. On the other hand, a significant percentage of LWBS patients (26%) do have private insurance.…”