Review article: Leaving the emergency department without being seen

Abstract

Patients who leave the ED without being seen (LWBS) are unlikely to be satisfied with the quality of the service provided and might be at risk from conditions that have not been assessed or treated. We therefore examined the available research literature to inform the following questions: (i) In patients who attend for ED care, what factors are associated with the decision to LWBS? (ii) In patients who attend for ED care, are there adverse health outcomes associated with the decision to LWBS? (iii) Which interventions have been used to try to reduce the number of patients who attend for ED care and LWBS? From the available literature, there was insufficient evidence to draw firm conclusions; however, the literature does suggest that patients who LWBS have conditions of lower urgency and lower acuity, are more likely to be male and younger, and are likely to identify prolonged waiting times as a central concern. LWBS patients generally have very low rates of subsequent admission, and reports of serious adverse events are rare. Many LWBS patients go on to seek alternative medical attention, and they might have higher rates of ongoing symptoms at follow-up. Further research is recommended to include comprehensive cohort or well-designed case-control studies. These studies should assess a wide range of related factors, including patient, hospital and other relevant factors. They should compare outcomes for groups of LWBS patients with those who wait and should include cross-sectoral data mapping to truly detect re-attendance and admission rates.

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

“…A literature review concluded in 2008 that ''patients generally have very low rates of subsequent admission, and reports of serious adverse events are rare.'' 14 This may explain why some settings tolerate higher LWBS proportions. No study has evaluated predictive factors associated with an unfavourable outcome for children who LWBS.…”

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.…”

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

“…13,[35][36][37][38] La littérature internationale suggère plutôt des taux entre 0,06% et 20%. 5,7,9,10,16,17,20,24,28,29,32,33,39,40 Aussi, la durée moyenne de séjour dans les urgences au Québec est comparable à celle de notre étude soit de 8h16 min globalement et 16h43 pour les patients sur civières. 41 Cette étude rétrospective a permis de dresser un portrait des facteurs démographiques, cliniques et hospitaliers ayant un impact sur le nombre de DAPCM, pour les deux salles d'urgence du CHUS.…”

“…[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]…”