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Patients who leave the emergency department without being seen by a physician: a control-matched study

Published online by Cambridge University Press:  21 May 2015

Jose Monzon ,
Steven Marc Friedman ,
Collin Clarke  and
Tamara Arenovich
Jose Monzon
Affiliation:
University Health Network, Toronto, Ont.
Steven Marc Friedman*
Affiliation:
University Health Network, Toronto, Ont.
Collin Clarke
Affiliation:
University Health Network, Toronto, Ont.
Tamara Arenovich
Affiliation:
University Health Network, Toronto, Ont.
*
1F 502, Toronto Western Hospital, 399 Bathurst St., Toronto ON M5T 2S8; 416 603-5405, fax 416 923-3523, steven.friedman@uhn.on.ca

Abstract

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Objective:

To describe the socio-demographic characteristics and clinical outcomes of patients who leave the emergency department (ED) without being seen by a physician.

Methods:

This 3-month prospective study was conducted at a downtown Toronto teaching hospital. Patients who left the ED without being seen (LWBS) were matched with controls based on registration time and triage level. Subjects and controls were interviewed by telephone within 1 week after leaving the ED.

Results:

During the study period, 386 (3.57%) of 10 808 ED patients left without being seen. One-third of these had no fixed address or no telephone, and only 92 (23.8%) consented to a telephone interview. They cited excessive wait time as the most common reason for leaving the ED (in 36.7% of cases). Despite leaving the ED without being seen, they were no more likely than those in the control group to seek follow-up medical attention (70 % in both groups). Among those from both groups who did seek follow-up, the LWBS patients were more likely to do so the same day or the day after leaving the ED. The LWBS patients often lacked a regular physician (39.1% v. 21.7%; p = 0.01) and were more likely to attend an ED or urgent care clinic (34.8% v. 12.0%; p < 0.001). Controls were more likely to follow up with a family physician (37.0% v. 23.9%; p = 0.06). The LWBS and control groups did not differ in subjective health status at 48 hours after leaving the ED, nor in subsequent re-investigation in hospital.

Conclusions:

Patients who leave the ED without being seen have different socio-demographic features, methods of accessing the health care system, affiliations and expectations than the general ED population. They are often socially disenfranchised, with limited access to traditional primary care. These patients are generally low acuity, but they are at risk of important and avoidable adverse outcomes.

Keywords

emergency department leaversemergency department acuityemergency servicespatient satisfactionLWBS
Type
ED Administration • L’administration de la MU
Information
Canadian Journal of Emergency Medicine , Volume 7 , Issue 2 , March 2005 , pp. 107 - 113
Copyright
Copyright © Canadian Association of Emergency Physicians 2005

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