Patients Who Leave the Emergency Department Without Being Seen and Their Follow-Up Behavior: A Retrospective Descriptive Analysis

Abstract

Background: Past studies suggest that patients who leave without being seen by a physician (LWBS) from a hospital's emergency department (ED) represent a quality and safety concern, and thus LWBS rates have often been used as an ED performance metric.There are few recent studies, however, that have examined the characteristics of the LWBS population at hospitals in the United States.Objectives: This study describes the LWBS population at a multi-hospital academic health system.Methods: This was a retrospective study of electronic medical record data from EDs at two academic hospitals with a shared patient population that analyzed all LWBS visits over the 45-month period between July 2012 and March 2016. Demographic and clinical variables including patient characteristics, chief complaint, acuity, and evidence of ongoing medical care were assessed.Results: Over the study period, 2.4% of patients presenting to the study EDs left without being seen. This population tended to have lower-acuity chief complaints and nearly triple the number of ED visits as the general ED patient. 7.8% sought follow-up care from outpatient clinics and 24.8% returned to the ED within 7 days. Of this latter group, 11.5% were subsequently admitted for inpatient care, representing 0.068% of the total ED census during the study period.Conclusions: LWBS patients are high ED utilizers who may be effectively targeted by "hotspotting." Our 11.5% admission rate at return after LWBS compares favorably with the overall 20.9% admission rate at the study EDs and represents a small minority of all LWBS visits. Given the paucity of return ED visits after interval clinic encounters, our Patients who leave the ED without being seen 2 data suggests that patients who were seen in clinic had their medical complaint adequately resolved on a non-emergent outpatient basis, and that increased LWBS rates may reflect poor access to timely clinic-based care rather than intrinsic systemic issues within the ED.

Patients leaving without being seen from the emergency department: A prediction model using machine learning on a nationwide database

“…An association with poverty (which we found by analyzing subjects from zip codes with lower household incomes) was corroborated by a study by Hsia et al 5 Some studies have shown an urban location of patients in proximity to the hospital 22 to be a significant factor, but this was refuted by our analysis. Similar to our analysis, other studies have pointed out lower acuity at presentation to have a significant association with LWBS, 6,18,23 but no scholars have studied relationships with the presence of chronic conditions.…”

“…Adjusting for these might have created better models. Finally, the data available did not allow us to analyze the time from a previous visit or to identify high users of EDs, both of which have been shown to be important LWBS predictors 18 …”

Effect of fever or respiratory symptoms on leaving without being seen during the COVID-19 pandemic in South Korea

“…Leave without being seen (LWBS) was defined as leaving the ED before consulting a physician after triage. LWBS is one of the factors reflecting the failure of the ED process, long waiting times, and ED overcrowding [ 10 , 11 ]. LWBS results in a higher chance of revisitation, since patients’ problems are often left unresolved [ 12 , 13 ].…”

Identifying Barriers to and Opportunities for Telehealth Implementation Amidst the COVID-19 Pandemic by Using a Human Factors Approach: A Leap Into the Future of Health Care Delivery? (Preprint)

“…However, for longer-term sustainability, performance-based outcome metrics are needed to assess the impact of telehealth on health systems. A few studies have made initial attempts to apply existing performance metrics to assess telehealth implementation [36,37]. The outcome measures we propose (Table 2) can help guide future work in optimizing and scaling telehealth implementation.…”