Walk-out patients in the hospital emergency department

Gibson, Geoffrey; Maiman, Lois A.; Chase, Anne M.

doi:10.1016/s0361-1124(78)80035-5

Cited by 25 publications

(19 citation statements)

References 1 publication

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“…11 Arriving between midnight and 4 am increases the odds of leaving without being seen by 5.9 compared with arriving between 8 pm and midnight. Being seen on the weekend is also associated with an increase in the rate of premature departure, 13,17,18 perhaps owing to higher patient volumes. In our ED, there was no significant difference in the rate between weekdays and the weekend, probably because we have staff available to care for patients with lower acuity 12 hours per day on the weekend, compared with only 6 hours per weekday.…”

Section: Discussionmentioning

confidence: 99%

Patients who leave the pediatric emergency department without being seen: a case-control study

Goldman

Macpherson²,

Schuh³

et al. 2005

Canadian Medical Association Journal

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Section: Discussionmentioning

confidence: 99%

Patients who leave the pediatric emergency department without being seen: a case-control study

Goldman

Macpherson²,

Schuh³

et al. 2005

Canadian Medical Association Journal

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“…6,12,15 Many studies have described the patients who LWBS as one with low acuity. 6 Gibson et al 13 have described ''walkout patients'' having ''less subjective tolerance for waiting,'' whereas Wartman et al 16 have described the patient who LWBS ''as a person who lives within 2.5 miles of the hospital, has either Medicare/ Medicaid or no medical insurance, has no private physician, and has a nonserious presenting complaint.'' There is generalized apprehension regarding the morbidity and possible mortality of these patients.…”

Section: Discussionmentioning

confidence: 99%

Patients Who Leave Our Emergency Department Without Being Seen

Kronfol¹,

Childers²,

Caviness³

2006

Pediatric Emergency Care

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Objectives: As the number of individuals seeking emergency care has increased during the last decade, the challenges facing emergency departments (EDs) have grown. These include overcrowding, increasing wait times, and an increasing number of patients who leave without being seen by a medical professional. We sought to describe the clinical characteristics of patients leaving the Texas Children's Hospital (TCH) ED without being seen during 1.5-year period as well as the predictors of further treatment received by these patients. Methods: We prospectively conducted a simple random sample of patients who left the TCH ED without being seen to determine their demographic and clinical characteristics as well as their clinical outcomes. Frequencies and measures of central tendency were used to describe the study population. Univariate and multivariate analyses were conducted to determine the predictors of receiving treatment elsewhere after leaving the TCH ED. Results: Almost all study patients identified a primary care provider (PCP), and the most patients who left sought care with their PCP within 8 hours. Almost half the patients arrived during the busy evening hours between 7 and 11 PM, and the median wait time before leaving was 3 hours. Almost half of the patients reported receiving treatment elsewhere, and 4% were admitted elsewhere. Those ill longer than 24 hours were almost 3 times as likely to receive treatment elsewhere. Almost all patients were clinically better by the time of telephone follow-up, and no patient had died. Conclusions: Our findings suggest that most patients who leave the ED without being seen have PCPs and seek care elsewhere after they leave. However, most patients are not sick enough to warrant admission elsewhere and probably could have waited to see their PCP rather than come to the ED.A ccess to health care is an important concern for all Americans. Without other resources, many patients rely on the emergency department (ED) as a ''safety net'' for medical care. Emergency department personnel are driven by ethical and legal responsibilities to provide care, but patients who leave without being seen (LWBS) by a medical professional are a particular challenge. Various frequencies of LWBS have been reported with numbers ranging from 1% to 15% 1 -3 in the general ED patient population. Reported pediatric frequencies in North America range from 0.2% to 3.9%. 4 -6 Other studies have sought to identify factors that increase departure from the ED without receiving medical evaluation. Wait time to be seen was shown to be the most common factor in patient departures. 3 -5,7 -9 In a pediatric study, children who left the ED without being seen had lower acuity levels and were more likely to be taken elsewhere for follow-up care than children who stayed. 6 Total number of patients seen in the ED was the most powerful predictor of LWBS in another study. 10 Patients listed communication of wait times and availability of immediate temporary treatments as reasons that would keep them from leaving. 1...

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“…16 Thompson and coworkers report that perceptions regarding waiting times and severity of illness, information delivery, and expressive quality predict patient satisfaction, and actual waiting times do not. 16,19 Patients are likely to be least satisfied when waiting times exceed expectations, relatively satisfied when waiting times are relatively matched with expectations, and highly satisfied when waits are shorter than expected. Boudreaux and associates noted that "emergent" patients in their ED were more satisfied than "urgent" and "routine" patients; the greater satisfaction was related not solely to the fact that emergency patients were seen quicker, but that they perceived their throughput times more favourably than other patients, especially their wait for physician evaluation.…”

Section: Wait Time and Satisfactionmentioning

confidence: 99%

“…Several authors have proposed informing and updating patients about estimated waiting times. 12,18,19,24 Emergency department staff should recognize that the socially disenfranchised may have different expectations and comfort levels in the ED environment, and may imagine or correctly perceive disrespect or bias on the part of health care personnel. Heightened attentiveness and compassion on the part of providers might be an efficient way to reduce the incidence of patients leaving without being seen.…”

Section: Reducing Lwbs Ratesmentioning

confidence: 99%

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

Monzón

Friedman²,

Clarke³

et al. 2005

CJEM

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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

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Walk-out patients in the hospital emergency department

Cited by 25 publications

References 1 publication

Patients who leave the pediatric emergency department without being seen: a case-control study

Patients who leave the pediatric emergency department without being seen: a case-control study

Patients Who Leave Our Emergency Department Without Being Seen

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

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