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

Abstract

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.

Effects of Emergency Department Expansion on Emergency Department Patient Flow

“…Extrapolating over an entire year, a sustained 1% decrease in the LWBT rate at the study institution would result in more than 500 additional adult patients being treated. As over 10% of patients who leave without being treated return to an ED for care within 72 hours, and approximately 4% are ultimately admitted to a hospital, 22,23,25 a sustained decrease in the LWBT rate would result in more timely provision of definitive care for patients.…”

“…Candidate predictor variables were selected based on literature review. 17,18,22,23 Those considered in the LWBT model included ED adult volume, ED low-acuity area volume, number of coded adult trauma activation patients, total ED wait time, total ED boarding hours, and ED nurse staffing hours. Candidate variables for the ED boarding model included number of ED admissions, number of ED admissions to the ICU, number of elective surgical admissions, hospital occupancy rate, ICU occupancy rate, and number of operational ICU beds.…”

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

“…[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.…”

“…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]…”

Children Who Leave the Emergency Department Without Being Seen: Why Did They Leave and What Would Make Them Stay?

“…1,[12][13][14][15][16][17][18][19] It is a multifactorial problem that is, at its core, related to an imbalance between ED crowding and available resources. 20,21 LWBS rates are globally considered to be direct quality of care indicators, 3,25,[28][29][30] especially in paediatric services, 31,32 representing concerns for health care providers and policymakers. 3 Although some studies have indicated that LWBS are more likely to have non-urgent illnesses, 2,9,12,13,15,18 Revista Científica da Ordem dos Médicos www.actamedicaportuguesa.com Sousa R, et al Children who leave the emergency department without being seen, Acta Med Port 2018 Feb;31 (2): [109][110][111][112][113][114] others have highlighted the potential risk of adverse outcomes, including the deterioration of patients' condition secondary to the delayed diagnosis or treatment.…”