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

Abstract

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.

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.…”

“…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]…”

Impact of Emergency Department Phlebotomists on Left-Before-Treatment-Completion Rates

“…Of these, approximately two-thirds leave before being seen (LBBS) by a physician or physician extender, with the remaining one-third leaving subsequent to being seen (LSBS) 6. LBTC encounters increase ED recidivism, potentially damage the reputation and trust of the healthcare institution with the community, and result in lost revenue 6,9,10–13. These encounters are considered “missed opportunities” for the healthcare system 9,14.…”

“…LBTC encounters increase ED recidivism, potentially damage the reputation and trust of the healthcare institution with the community, and result in lost revenue 6,9,10–13. These encounters are considered “missed opportunities” for the healthcare system 9,14. Accordingly, the proportion of LBBS encounters is used by the Centers for Medicare & Medicaid Services (CMS) as a hospital quality indicator, with previous investigators estimating the desirable LBBS goal at <2% 4,15…”

Identifying Patient Door-to-Room Goals to Minimize Left-Without-Being-Seen Rates

“…One of the most intuitively obvious variables influencing LWBS rates is the time interval from the patient’s initial ED presentation to being seen by a physician. 10 Previous work focusing on ED length of stay (LOS) and related operations parameters have identified prolonged “wait times” as the most important factor driving LWBS rates. 11 , 12 …”