Patients leaving the emergency department without being seen by a physician: a retrospective database analysis

Grosgurin, Olivier; Cramer, Bérénice; Schaller, Mathilde; Sarasin, F. P.; Rutschmann, O.

doi:10.4414/smw.2013.13889

Cited by 12 publications

(17 citation statements)

References 10 publications

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“…For example, weekend presentation has been identified as being independently associated with high LWBS in previous work (from locations as disparate as Australia and Switzerland). 28 , 29 This finding was not replicated in the current analysis (p for day of week=0.53), emphasizing the importance of applying the analytic principles outlined here (and elsewhere) to one’s own patient population to determine the most important factors driving LWBS.…”

Section: Discussioncontrasting

confidence: 54%

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

Pielsticker¹,

Whelan²,

Arthur³

et al. 2015

WestJEM

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IntroductionEmergency department (ED) patients in the leave-without-being-seen (LWBS) group risk problems of inefficiency, medical risk, and financial loss. The goal at our hospital is to limit LWBS to <1%. This study’s goal was to assess the influence on LWBS associated with prolonging intervals between patient presentation and placement in an exam room (DoorRoom time). This study’s major aim was to identify DoorRoom cutoffs that maximize likelihood of meeting the LWBS goal (i.e. <1%).MethodsWe conducted the study over one year (8/13–8/14) using operations data for an ED with annual census ~50,000. For each study day, the LWBS endpoint (i.e. was LWBS <1%: “yes or no”) and the mean DoorRoom time were recorded. We categorized DoorRoom means by intervals starting with ≤10min and ending at >60min. Multivariate logistic regression was used to assess for DoorRoom cutoffs predicting high LWBS, while adjusting for patient acuity (triage scores and admission %) and operations parameters. We used predictive marginal probability to assess utility of the regression-generated cutoffs. We defined statistical significance at p<0.05 and report odds ratio (OR) and 95% confidence intervals (CI).ResultsUnivariate results suggested a primary DoorRoom cutoff of 20′, to maintain a high likelihood (>85%) of meeting the LWBS goal. A secondary DoorRoom cutoff was indicated at 35′, to prevent a precipitous drop-off in likelihood of meeting the LWBS goal, from 61.1% at 35′ to 34.4% at 40′. Predictive marginal analysis using multivariate techniques to control for operational and patient-acuity factors confirmed the 20′ and 35′ cutoffs as significant (p<0.001). Days with DoorRoom between 21–35′ were 74% less likely to meet the LWBS goal than days with DoorRoom ≤20′ (OR 0.26, 95% CI [0.13–0.53]). Days with DoorRoom >35′ were a further 75% less likely to meet the LWBS goal than days with DoorRoom of 21–35′ (OR 0.25, 95% CI [0.15–0.41]).ConclusionOperationally useful DoorRoom cutoffs can be identified, which allow for rational establishment of performance goals for the ED attempting to minimize LWBS.

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Section: Discussioncontrasting

confidence: 54%

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

Pielsticker¹,

Whelan²,

Arthur³

et al. 2015

WestJEM

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“…For comparison, in a study in Switzerland, it was reported that 57,645 patients were admitted to the ED of an urban teaching hospital in the year 2008. [6] …”

Section: Discussionmentioning

confidence: 99%

Reasons for Overcrowding in the Emergency Department: Experiences and Suggestions of an Education and Research Hospital

Erenler

Akbulut

Güzel

et al. 2014

Turkish Journal of Emergency Medicine

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SUMMARYObjectivesIn this study, we aimed to determine the causes of overcrowding in the Emergency Department (ED) and make recommendations to help reduce length of stay (LOS) of patients in the ED.MethodsWe analyzed the medical data of patients admitted to our ER in a one-year period. Demographic characteristics, LOS, revisit frequency, and consultation status of the patients were determined.ResultsA total of 163,951 patients were admitted to our ED between January 1, 2013, and December 31, 2013. In this period 1,210 patients revisited the ED within 24 hours. A total of 38,579 patients had their treatment in the observation room (OR) of the ED and mean LOS was found to be 164.1 minutes. Cardiology was the most frequently consulted specialty. Mean arrival time of the consultants in ED was 64 minutes.ConclusionsSimilar to EDs in other parts of the world, prolonged length of stay in the ED, delayed laboratory and imaging tests, delay of consultants, and lack of sufficient inpatient beds are the most important causes of overcrowding in the ED. Some drastic measures must be taken to minimize errors and increase satisfaction ratio.

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“…In Europe, only a limited number of studies have been conducted [4, 22]. In order to get a better picture of the evolution over time of these “missed opportunities,” a retrospective study of patients leaving the ED of a Swiss tertiary university hospital before being seen or against medical advice was conducted for the period 2005–2010.…”

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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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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Patients leaving the emergency department without being seen by a physician: a retrospective database analysis

Abstract: LWBS patients share some characteristics and a better understanding of these characteristics as well as time and logistic issues could ease to implement strategies to reduce premature leaving from the ED.

Cited by 12 publications

References 10 publications

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

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

Reasons for Overcrowding in the Emergency Department: Experiences and Suggestions of an Education and Research Hospital

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

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