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

Published online by Cambridge University Press:  21 May 2015

Jose Monzon ,
Steven Marc Friedman ,
Collin Clarke  and
Tamara Arenovich
Jose Monzon
Affiliation:
University Health Network, Toronto, Ont.
Steven Marc Friedman*
Affiliation:
University Health Network, Toronto, Ont.
Collin Clarke
Affiliation:
University Health Network, Toronto, Ont.
Tamara Arenovich
Affiliation:
University Health Network, Toronto, Ont.
*
1F 502, Toronto Western Hospital, 399 Bathurst St., Toronto ON M5T 2S8; 416 603-5405, fax 416 923-3523, steven.friedman@uhn.on.ca

Abstract

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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. One-third 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.

Keywords

emergency department leaversemergency department acuityemergency servicespatient satisfactionLWBS
Type
ED Administration • L’administration de la MU
Information
Canadian Journal of Emergency Medicine , Volume 7 , Issue 2 , March 2005 , pp. 107 - 113
Copyright
Copyright © Canadian Association of Emergency Physicians 2005

References

1.Koska, MT.Indigent care and overcrowding threaten EDs. Hospitals 1989;63(14):66–70.Google Scholar
2.Ullman, R, Block, JA, Stratmann, WC.An emergency room’s patients: their characteristics and utilization of hospital services. Med Care 1975;13(12):1011–20.Google Scholar
3.Health Reports — Hospital Annual Statistics, Vol 1–5, cat no 82-003S20. Ottawa (ON): Statistics Canada;1992.Google Scholar
4.Baker, DW, Stevens, CD, Brook, RH.Patients who leave a public hospital emergency department without being seen by a physician. Causes and consequences. JAMA 1991;266(8):1085–90.Google Scholar
5.Bindman, AB, Grumbach, K, Keane, D, Rauch, L, Luce, JM.Consequences of queuing for care at a public hospital emergency department. JAMA 1991;266(8):1091–6.CrossRefGoogle Scholar
6.Dershewitz, RA, Paichel, W.Patients who leave a pediatric emergency department without treatment. Ann Emerg Med 1986;15(6):717–20.CrossRefGoogle ScholarPubMed
7.Dos Santos, LM, Stewart, G, Rosenberg, NM.Pediatric emergency department walk-outs. Pediat Emerg Care 1994:10(2):76–8.Google Scholar
8.Hobbs, D, Kunzman, SC, Tandberg, D, Sklar, D.Hospital factors associated with emergency center patients leaving without being seen. Am J Emerg Med 2000;18(7):767–72.Google Scholar
9.McNamara, KJ.Patients leaving the ED without being seen by a physician: Is same-day follow-up indicated? Am J Emerg Med 1995;13(2):136–41.CrossRefGoogle ScholarPubMed
10.Fernandes, CM, Price, A, Christenson, JM.Does reduced length of stay decrease the number of emergency department patients who leave without seeing a physician? J Emerg Med 1997;15(3):397–9.CrossRefGoogle ScholarPubMed
11.Sainsbury, SJ.Emergency patients who leave without being seen: are urgently ill or injured patients leaving without care? Mil Med 1990;155(10):460–4.Google Scholar
12.Weissberg, MP, Heitner, M, Lowenstein, SR, Keefer, G.Patients who leave without being seen. Ann Emerg Med 1986;15(7):813–7.Google Scholar
13.Stock, LM, Bradley, GE, Lewis, RJ, Baker, DW, Sipsey, J, Stevens, CD.Patients who leave emergency departments without being seen by a physician: magnitude of the problem in Los Angeles County. Ann Emerg Med 1994;23(2):294–8.Google Scholar
14.Wartman, SA, Taggart, MP, Palm, E.Emergency room leavers: a demographic and interview profile. J Commun Health 1984;9(4):261–8.CrossRefGoogle ScholarPubMed
15.Beveridge, R, Clarke, B, Janes, L, Savage, N, Thompson, J, Dodd, G, et al.Canadian Emergency Department Triage and Acuity Scale: implementation guidelines. Can J Emerg Med 1999;1(3 suppl). Online version available at: www.caep.ca/002.policies/002-02.ctas.htm (accessed 15 Feb 2005).Google Scholar
16.Thompson, DA, Yarnold, PR, Williams, DR, Adams, SL.Effects of actual waiting time, perceived waiting time, information delivery, and expressive quality on patient satisfaction in the emergency department. Ann Emerg Med 1996;28(6):657–65.Google Scholar
17.Fernandes, CM, Daya, MR, Barry, S, Palmer, N.Emergency department patients who leave without seeing a physician: the Toronto Hospital experience. Ann Emerg Med 1994;24:1092–6.Google Scholar
18.Arendt, KW, Sadosty, AT, Weaver, AL, Brent, CR, Boie, ET.The left-without-being-seen patients: What would keep them from leaving? Ann Emerg Med 2003;42(3):317–23.Google Scholar
19.Gibson, G, Maiman, LA, Chase, AM.Walk-out patients in the hospital emergency department. JACEP 1978;7(2):47–50.CrossRefGoogle ScholarPubMed
20.Boudreaux, ED, Friedman, J, Chansky, ME, Baumann, BM.Emergency department patient satisfaction: examining the role of acuity. Acad Emerg Med 2004;11(2):162–8.CrossRefGoogle ScholarPubMed
21.Graff, L, Steven, C, Spaite, D, Foody, J.Measuring and improving quality in emergency medicine, Acad Emerg Med 2002;9: 1091–107.Google Scholar
22.Trzeciak, S, Rivers, EP.Emergency department overcrowding in the United States: an emerging threat to patient safety and public health. Emerg Med J 2003;20:402–5.Google Scholar
23.Tucker, JB, Barone, JE, Ceceer, J, Blabey, RG, Rha, CK, et al.Using queuing theory to determine operating room staffing needs. J Trauma 1999;46(1):71–9.Google Scholar
24.Lombardi, G, Eisner, N, Gennis, P.Effect of periodic waiting time announcements on patient walk-outs in a municipal hospital ED [presentation]. Society of Academic Emergency Medicine Annual Meeting, San Antonio, Tex, May 21–24, 1995.Google Scholar
25.Liao, HC, Liaw, SJ, Hu, PM, Lee, KT, Chen, CM.Wang, FL.Emergency department patients who leave without being seen by a doctor: The experience of a medical center in northern Taiwan. Chang Gung Med J 2002;25(6):367–73.Google Scholar