Leaving the emergency department without complete care: disparities in American Indian children

Abstract

BackgroundChildren who leave the emergency department (ED) without complete evaluation or care (LWCET) have poorer outcomes in general. Previous studies have found that American Indian (AI) children have higher rates of LWCET than other racial or ethnic groups. Therefore, this study aims to examine LWCET in AI children by exploring differences by ED location and utilization patterns.MethodsThis is a retrospective cohort study of five EDs in the upper Midwest between June 2011 and May 2012. We included all visits by children aged 0–17 who identified as African American (AA), AI or White. Logistic regression was used to determine differences in LWCET by race and ED location controlling for other possible confounding factors including sex, age, insurance type, triage level, distance from ED, timing of visit, and ED activity level.ResultsLWCET occurred in 1.73% of 68,461 visits made by 47,228 children. The multivariate model revealed that AIs were more likely to LWCET compared to White children (Odds Ratio (OR) = 1.62, 95% Confidence Interval (CI) = 1.30–2.03). There was no significant difference in LWCET between AA and White children. Other factors significantly associated with LWCET included triage level, distance from the ED, timing of visit, and ED activity level.ConclusionOur results show that AI children have higher rates of LWCET compared to White children; this association is different from other racial minority groups. There are likely complex factors affecting LWCET in AI children throughout the upper Midwest, which necessitates further exploration.

First Nations emergency care in Alberta: descriptive results of a retrospective cohort study

“…Findings of higher rates of FN patients leaving without being seen and leaving against medical advice are similar to earlier US findings for American Indian populations [ 22 , 70 ], for FN Chronic Obstructive Pulmonary Disorder patients in Alberta emergency departments [ 21 ], and for FN abdominal pain patients in a Saskatchewan emergency department [ 20 ]. Patients who leave emergency care without completing treatment may be at risk of returning to emergency facilities [ 71 ] and admissions to hospital [ 71 , 72 ].…”

“…While it is laudable that emergency medicine provides accessible care for underserved groups, disparities in emergency care for racial and ethnic minorities are well documented [ 18 , 19 ]. Indigenous patients specifically have been reported to leave emergency departments more often without being seen [ 16 , 20 – 22 ], potentially indicating dissatisfaction with care. Canadian qualitative research documents patient concerns about differential treatment based on race and experiences of marginalization in health care [ 23 , 24 ].…”

Characteristics of youth who leave the emergency department without being seen following sports-related concussion

“…This apparent disparity in ED disposition by race is concerning. Previous research has shown a similar association between nonwhite race and LWBS [24,29,30]; however, this study is the first to identify potential racial disparities in LWBS among youth with concussion. Given that racial disparities in ED treatment of concussion exist [31], further research with more detailed data is needed to examine this and other possible factors associated with treatment and disposition among youth with concussion.…”

The Impacts of COVID-19 on Healthcare Quality in Tertiary Medical Centers—A Retrospective Study on Data from Taiwan Clinical Performance Indicators System

“…The percentage of patients leaving the ER without complete evaluation or treatment ranged from 0.1% to 15% in the literature [ 19 , 20 , 21 ]. The reasons for patients leaving the ER without complete evaluation or treatment might be due to prolonged waiting time, resolved symptoms [ 20 , 21 ], feeling too ill to wait [ 20 ], self-referral to the hospital’s out-patient department [ 21 ], the patient lives close to the ER, and insurance status [ 22 ]. Our results showed that the average rate of patients leaving the ER without complete evaluation or treatment was around 3%, which was comparable with the abovementioned studies.…”