Emergency department patients who leave the department without being seen by a doctor

Khanna, Renu; Ma, Chaudhry; Prescott, M. C.

doi:10.1097/00063110-199909000-00011

Cited by 13 publications

(17 citation statements)

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“…In most cases, prolonged waiting time and ER overcrowding are the main reasons for leaving [5, 10, 33, 43]. Other reasons cited in the literature include spontaneously improved symptoms, a conflict with the treatment team, or work or family commitments [5, 10, 14, 43]. Direct links between the waiting times and the proportion of patients who leave the ER have been shown many times (Table 3) and are often used as indicators of the quality of the ER in the USA [3, 24–26, 30, 35, 41, 44].…”

Section: Discussionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

“…This refers to patients who leave the ED from the waiting room, after having completed their administrative paperwork and usually an initial evaluation by a triage nurse (TN). The reported rate of LWBS patients is between 0.1% and 15% of consultations to the ED, depending on the type and size of the hospital [1–14]. …”

Section: Introductionmentioning

confidence: 99%

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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“…Characteristics of DNW patients previously identified in the published research include being a young male, 5 , 6 , 11 , 12 , 14 not being married, 2 , 9 having lower socioeconomic 5 , 6 , 9 , 15 and educational 15 status, with English not the primary language, 6 and not having private health insurance 6 , 15 . Of particular note and interest within Australia are Aboriginals, who are 37% more likely not to wait than other Australians 6 …”

Section: Discussionmentioning

confidence: 99%

Characteristics and outcomes of patients who “did not wait” after attending Perth public hospital emergency departments, 2000–2003

Hall

Jelinek

2007

Medical Journal of Australia

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Objective: To determine characteristics and outcomes of patients who did not wait to see a doctor in emergency departments (EDs). Design and setting: Population‐based outcome study using probabilistically linked ED and Western Australian death records, with ED records from all seven Perth public hospitals that have EDs from 1 July 2000 to 30 June 2003. Main outcome measures: Rates of “did not wait” (DNW) presentations, overall and for individual hospitals; characteristics of DNW patients; mortality rates among DNW patients at 2, 7 and 30 days. Results: DNW rates varied from 2.6% to 6.3% (average, 4.1%) and were generally lower in tertiary teaching hospitals. DNW patients had conditions of lower urgency, predominantly Australasian Triage Scale category 4 (67.1%) and 5 (23.4%). The DNW rates in these categories were 5.8% and 10.6%, respectively (P < 0.001). Patients referred by health care providers had lower DNW rates (0.5%; P < 0.001). DNW patients were more frequently male (4.4% v 3.8%; P < 0.001), and young to middle‐aged adults (15–44 years; 5.8%; P < 0.001). Patients with a higher than average DNW rate were more likely to arrive by private transport (5.0%; P < 0.001) or with police (5.8%; P < 0.001), re‐present for review (8.6%; P < 0.001) or have social or behavioural problems (7.7%; P < 0.001). Most patients (91.9%) did not wait on only one occasion. The 30‐day mortality rate among DNW patients was significantly lower than for patients seen by a doctor and discharged (0.14 v 0.20%; P = 0.026), and for all patients seen in the ED (1.28%; P < 0.001). Conclusions: Patients who did not wait for medical assessment in Perth EDs had conditions of lower acuity and had lower mortality rates than those who waited for assessment.

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“…Goldman et al 17 reported only one child who was admitted out of 289 compared with 8% of the control group. Khanna et al 23 found that out of 102 patients, only one required admission. Bindman et al 2 reported that only 4% of patients needed subsequent hospitalisation.…”

Section: Discussionmentioning

confidence: 99%

Did Not Wait Patient Management Strategy (DNW PMS) Study

et al. 2011

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Objectives This study was undertaken to assess the usefulness of senior emergency medicine specialists' review of all 'did not wait' (DNW) patients' triage notes and the recall of at-risk patients. Methods A prospective study of all DNW patients was performed from 1 January to 31 December 2008. Following a daily review of charts of those who failed to wait to be seen, those patients considered to be at risk of adverse outcome were contacted by the liaison team and advised to return. Data were gathered on all DNW patients on the Oracle database and interrogated using the Diver solution.Results 2872 (6.3%) of 45 959 patients did not wait to be seen. 107 (3.7%) were recalled on the basis of senior emergency medicine doctor review of the patients' triage notes. Variables found to be associated with increased likelihood of being recalled included triage category (p<0.001), male sex (p<0.004) and certain clinical presentations. The presenting complaints associated with being recalled were chest pain (p<0.001) and alcohol/drug overdose (p¼0.001). 9.4% of DNW patients required admission following recall. Conclusion The systematic senior doctor review of triage notes led to 3.7% of patients who failed to wait being recalled. 9.4% of those recalled required acute admission. The daily review of DNW patients' triage notes and the recalling of at-risk patients is a valuable addition to our risk management strategy.Did not wait (DNW) patients represent an important subset of the emergency department (ED) population because of their high rates of representation and the potential for adverse outcomes. 1e7 The main reason for patients not waiting for medical assessment is prolonged waiting times. 1 2 5 8 Internationally DNW rates vary considerable from 0.1% to 15%. 2 7 9e12 In a previous study conducted by this group over a 14-week period the DNW rate in the research department was 7.47%.Previous international studies have focused on characterising the varying factors associated with DNW patients. These descriptive studies have found that younger male patients, arriving at weekends and at night with lower acuity problems, are more likely to leave without seeing a doctor. 11e14 A number of researchers have focused on the outcome of DNW patients through phonebased follow-up and mailing after time periods ranging from 24 h to 4 weeks. 3 5 7 12 15e17 While the rates of reported adverse events are low, a large proportion of patients are unaccounted for due to poor response rates and consequently accurate outcomes are unknown. A very limited number of studies have suggested an intervention to address this potentially worrying group of patients. 18e20 On a background of a high DNW rate it was decided to implement a risk assessment and management intervention strategy with the aim of reducing the potential for adverse outcomes. This research was performed to assess the usefulness of the strategy. METHODSA prospective study of all ED DNW patients was performed over a 1-year period between January and December 2008. It took place in a teac...

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Emergency department patients who leave the department without being seen by a doctor

Cited by 13 publications

References 0 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

Characteristics and outcomes of patients who “did not wait” after attending Perth public hospital emergency departments, 2000–2003

Did Not Wait Patient Management Strategy (DNW PMS) Study

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