Who leaves the emergency department without being seen? A public hospital experience in Georgetown, Guyana

Abstract

BackgroundLeft without being seen (LWBS) proportions are commonly used as quality control indicators, but little data is available on LWBS proportions in the developing world. This study sought to determine the proportion and characteristics of patients who LWBS from the emergency department (ED) of the main public hospital in Georgetown, Guyana.MethodsThis is a retrospective cross-sectional analysis of an ED quality assurance database. Registration personnel collected demographic information on patients presenting to the ED over a 2-week period in July 2010. Both univariate and multivariate analysis were conducted to determine patient characteristics associated with LWBS.ResultsThe LWBS proportion was 5.7%. In univariate analysis, patients 18 or older (OR 1.48, 95%CI 1.03-2.12), presenting during the 4PM-12AM shift (OR 2.15, 95%CI 1.53-3.01), with non-urgent triage classification (OR 1.88, 95%CI 1.76-4.66), with non-traumatic chief complaints (OR 1.70, 95%CI 1.14-2.55), or who were not transferred (OR 2.13, 95%CI 1.00-4.55) had significantly higher odds of LWBS. On multivariate analysis, only patients 18 or older (OR 1.54, 95%CI 1.02-2.33), presenting during the 4PM-12AM shift (OR 2.29, 95%CI 1.54-3.40), and with non-traumatic chief complaints (OR 2.39, 95%CI 1.43-4.02) were found to be significantly associated with LWBS. Sex, residence in the capital city, time to triage, transfer status, use of EMS, and triage classification were not statistically associated with LWBS.ConclusionsLWBS proportions are used as quality control indicators and this study determined the LWBS proportion at a public hospital in a developing country and some of the patient characteristics associated with LWBS. This can be helpful to develop strategies to decrease LWBS proportions and to assess progress over time.

Uncompleted Emergency Department Care (UEDC): a 5-year population-based study in Veneto Region, Italy.

“…It is notable, however, that 1% of the patients in our sample with the highest triage levels LWBS. As unexpected as this might seem, other studies also found that patients in the highest triage categories might still LWBS [ 36 ]. At the same time, the higher odds of LWBS events involving patients with non-traumatic conditions is to be expected given that most patients with injuries required acute attention, while those with a low acuity rating sought alternative medical care.…”

“…On the other hand, an important proportion of patients may be sufficiently reassured by their triage assessment and no longer feel such an urgent need to seek medical advice. Although it would seem that care for patients triaged as non-urgent could be deferred, studies have found that such patients may still be genuinely ill [ 36 ]. It is notable, however, that 1% of the patients in our sample with the highest triage levels LWBS.…”

Identifying Patient Door-to-Room Goals to Minimize Left-Without-Being-Seen Rates

“… 11 Studies around the world have demonstrated that triage acuity is regularly implicated as an important variable impacting LWBS rates. 5 , 25 – 27 The internal and external validity of the current study is enhanced by the fact that much of the ED LWBS literature also uses the ESI to assess triage acuity. 1 , 11 …”

Leaving The Emergency Department Without Being Seen or Without Complete Treatment; A Study From Saudi Arabia

“…Moreover, it is prudent to investigate the mortality rate of such patients. The literature revealed a range from 0.17% [6] to 35% [7], whereas several other studies lacked such data [1], [2], [8].…”