Early Quick Acuity Score Provides More Complete Data on Emergency Department Walkouts

Abstract

IntroductionMany prior studies have compared the acuity of Emergency Department (ED) patients who have Left Without Being Seen (LWBS) against non-LWBS patients. A weakness in these studies is that patients may walk out prior to the assignment of a triage score, biasing comparisons. We report an operational change whereby acuity was assessed immediately upon patient arrival. We hypothesized more patients would receive acuity scores with EQAS. We also sought to compare LWBS and non-LWBS patient characteristics with reduced bias.MethodsSetting: urban, academic medical center. Retrospective cohort study, electronic chart review, collecting data on all ED patients presenting between 4/1/2010 and 10/31/2011 (“Traditional Acuity Score” period, TAS) and from 11/1/2011 to 3/31/2012 (“Early Quick Acuity Score” period, EQAS). We recorded disposition (LWBS versus non-LWBS), acuity and demographics. For each subject during the EQAS period, we calculated how many prior ED visits and how many prior walkouts the subject had had during the TAS period.ResultsAcuity was recorded in 92,275 of 94,526 patients (97.6%) for TAS period, and 25,577 of 25,760 patients (99.3%) for EQAS period, a difference of 1.7% (1.5%, 1.8%). LWBS patients had acuity scores recorded in 5,180 of 7,040 cases (73.6%) during TAS period, compared with 897 of 1,010 cases (88.8%) during the EQAS period, a difference of 15.2% (14.8%, 15.7%). LWBS were more likely than non-LWBS to be male, were younger and had lower acuity scores. LWBS averaged 5.3 prior ED visits compared with 2.8 by non-LWBS, a difference of 2.5 (1.5, 3.5). LWBS averaged 1.3 prior ED walkouts compared with 0.2 among non-LWBS, a difference of 1.1 (0.8, 1.3).ConclusionsEQAS resulted in a higher proportion of patients receiving acuity scores, particularly among LWBS. This offers more complete data when comparing LWBS and non-LWBS patient characteristics. The comparison reinforced findings from prior studies.

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.…”

“…Le taux d'occupation est un facteur reconnu augmentant le taux de DAPCM. 10,24 Le temps est responsable du DAPCM dans 35,6% à 63,8% des cas. 4,5,[25][26][27] Notre analyse multivariée soutient cette relation, car pour chaque augmentation d'une heure dans la durée moyenne de séjour des patients non hospitalisés à l'urgence, nous observons une augmentation moyenne de 1,17 (HF) et 1,14 (HD) patients par jour faisant un DAPCM.…”

“…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]…”