DNW--"Did Not Wait" or "Demographic Needing Work": a study of the profile of patients who did not wait to be seen in an Irish emergency department

Gilligan, Peadar; Joseph, Danny; Winder, Stephen; Keeffe, F O’; Oladipo, OO; Ayodele, T Onigbinde; Asuquo, Q; O’Kelly, Patrick; Hegarty, D

doi:10.1136/emj.2008.063388

Cited by 23 publications

(34 citation statements)

References 18 publications

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“…Our results are also in accordance with previous publications, showing that LWBS patients have a wide range of complaints, with musculoskeletal and gastrointestinal complaints ranked first, and a low acuity level [12, 29, 31]. Unlike other studies, complaints related to wounds are infrequent in our study, possibly reflecting a low rate of stab wounds [31].…”

Section: Discussionsupporting

confidence: 92%

Missed Opportunities: Evolution of Patients Leaving without Being Seen or against Medical Advice during a Six-Year Period in a Swiss Tertiary Hospital Emergency Department

Carron

Yersin

Trueb

et al. 2014

BioMed Research International

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Aim. The study aimed at describing the evolution over a 6-year period of patients leaving the emergency department (ED) before being seen (“left without being seen” or LWBS) or against medical advice (“left against medical advice” or LAMA) and at describing their characteristics. Methods. A retrospective database analysis of all adult patients who are admitted to the ED, between 2005 and 2010, and who left before being evaluated or against medical advice, in a tertiary university hospital. Results. During the study period, among the 307,716 patients who were registered in the ED, 1,157 LWBS (0.4%) and 1,853 LAMA (0.9%) patients were identified. These proportions remained stable over the period. The patients had an average age of 38.5 ± 15.9 years for LWBS and 41.9 ± 17.4 years for LAMA. The median time spent in the ED before leaving was 102.4 minutes for the LWBS patients and 226 minutes for LAMA patients. The most frequent reason for LAMA was related to the excessive length of stay. Conclusion. The rates of LWBS and LAMA patients were low and remained stable. The patients shared similar characteristics and reasons for leaving were largely related to the length of stay or waiting time.

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Section: Discussionsupporting

confidence: 92%

Missed Opportunities: Evolution of Patients Leaving without Being Seen or against Medical Advice during a Six-Year Period in a Swiss Tertiary Hospital Emergency Department

Carron

Yersin

Trueb

et al. 2014

BioMed Research International

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“…15,16 In a study by Goldman et al, 13 patients were statistically more likely to LWBS if they presented during the night shift; similar results have been found in studies of adult patients who LWBS. 4,7,24 Rates of LWBS showed seasonal variations. Patients were more likely to LWBS if they presented to the ED during the winter and spring.…”

Section: Discussionmentioning

confidence: 99%

Who Are the Children Leaving the Emergency Department Without Being Seen by a Physician?

Gaucher

Bailey

Gravel

2011

Academic Emergency Medicine

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“…Like other studies, we found that patients who LWBS present with conditions of lower urgency, are more likely to be younger patients, to be male, to have arrived without assisted transport, to have self-referred, to be of indigenous Australian background, to be from non-English-speaking backgrounds, and to have arrived in the evening. 2,[15][16][17] The relationship of LWBS with indigenous status is important. Based on data from the Australian Bureau of Statistics, Victoria has a low level of indigenous population compared to the overall data for Australia; 18 however, the issues contributing to higher risk of LWBS for this patient population will need further exploration to tailor effective interventional strategies.…”

Section: Discussionmentioning

confidence: 99%

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

Tropea

Sundararajan

Gorelik

et al. 2012

Academic Emergency Medicine

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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.

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DNW--"Did Not Wait" or "Demographic Needing Work": a study of the profile of patients who did not wait to be seen in an Irish emergency department

Abstract: Failure to provide the service in a timely manner gives rise to patients leaving without receiving the medical assessment they came to obtain. This is a serious clinical problem and puts both those requiring care and those providing it at risk of adverse outcomes.

Cited by 23 publications

References 18 publications

Missed Opportunities: Evolution of Patients Leaving without Being Seen or against Medical Advice during a Six-Year Period in a Swiss Tertiary Hospital Emergency Department

Missed Opportunities: Evolution of Patients Leaving without Being Seen or against Medical Advice during a Six-Year Period in a Swiss Tertiary Hospital Emergency Department

Who Are the Children Leaving the Emergency Department Without Being Seen by a Physician?

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

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