Patients Who Presented to an Australian Emergency Department and Did Not Wait or Left Against Medical Advice

Abstract

This study aimed to describe characteristics, outcomes, and post-emergency department (ED) departure medical requirements of patients who did not wait (DNW) or left against medical advice (LAMA) after presenting to an Australian hospital ED over a 6-month period. This was a prospective cohort follow-up study. Children and adults were compared in terms of ED characteristics and outcomes. Of the 32,333 patient presentations, 3,293 (10.2%) were recorded as DNW and 470 (1.5%) as LAMA. Of the DNW/LAMA presentations, 1,303 (34.6%) received a telephone call. One in four of the DNW/LAMA patients were children (<16 years). Most (87%) waited longer than the recommended time before leaving the ED, the majority (56%) sought care elsewhere, and some (n = 174, 13%) re-presented to the ED within 7 days; 20 of those required hospital admission. Strategies addressing front-end ED systems are required to mitigate the proportion of patients who DNW/LAMA.

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.…”

“…2 Ces patients faisant un DAPCM ont un risque moindre ou égal aux autres patients de mal évoluer, d'avoir besoin de soins médicaux ultérieurement ou d'avoir des symptômes prolongés. 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,…”

Children Who Leave the Emergency Department Without Being Seen: Why Did They Leave and What Would Make Them Stay?

“…In addition, our response rate was higher than the one reported by similar studies. 11,[24][25][26] Finally, the format of the telephone survey constitutes another possible limitation, as responses might have been different through anonymous feedback. Furthermore, the time passed between the ED visit and the telephone survey introduces the potential for recall bias.…”

“…18 However, only few studies have analysed parental reasons for leaving 14,17,23,25,26 and subsequent outcome. 9,14,15,[23][24][25]27 In this study, we aimed to compare the sociodemographic characteristics of children who LWBS and of those who did not leave. Moreover, we intended to evaluate parental reasoning for leaving, subsequent use of medical care and patient outcome.…”

“…8 Previous studies have analysed how different factors (including demographic, temporal and care related features) influence the incidence of LWBS. 1,9,[12][13][14][15]17,[22][23][24][25] For the most part, prolonged waiting time seems to play a major role. [12][13][14]17,18,23,25 In a previous study by our group, we demonstrated that, after adjusting for the waiting time, the lower triage category and admission between 4 pm and midnight were associated with a higher risk of LWBS.…”