ResearchPatients Who Leave the Emergency Department Without Being Seen
Section snippets
Study Design
This was a prospective descriptive study of patients who left the ED triage/waiting room area before being seen by a physician.
Study Setting and Population
The study took place in a mid-Atlantic level II trauma center and community teaching hospital with approximately 65,000 annual patient visits. The staffing in the triage area during 11 am to 11 pm, the peak hours for patient volume, consisted of 1 emergency care technician at the front desk and 2 registered nurses (RNs) in the triage examination rooms. After 11 pm,
Results
During the study period, 127 patients left without being seen. In the LWBS patient population, the mean age was 27.9 years, and 42.7% were male; in the total ED population, the mean age was 41.3 years and 48% were male (P < .001 for age). The LWBS population represented 1.1% of our total ED visits (11,147) during the 2-month study period. Of the eligible patients, 72 (56.7%) were contacted by phone, consented to be interviewed within 8 days of their LWBS ED visit, and completed the survey; thus
Discussion
ED crowding is defined, in part, as waiting more than 1 hour to see a physician.10 Our study has shown that this is the point in time when a patient may LWBS. The pediatric patients in this study waited approximately 23 minutes longer than adults before leaving without being seen. A large number of our patients (84.7%) had a primary physician, and over half of the patients were able to obtain medical care within 8 days of leaving the emergency department. The reasons for not initially seeing
Limitations
One limitation of this study is our small sample size. In addition, we were unable to contact by telephone 43.3% of the patients who left without being seen during our study period despite 3 attempts to do so. However, these patients had similar age and gender distributions when compared with the final sample. Of the 55 patients who we were unable to contact, age and gender data were available on 41 patients. Their mean age was 24.5 years and 41.5% were male (compared with 29.9 years and 44.4%
Implications for Emergency Nurses
The emergency nurse at triage should be aware that in our study, the mean wait time for patients who left without being seen was 70.4 minutes. Although the national wait time is slightly shorter, at 56 minutes, the triage nurse should pay careful attention to waiting patients as their wait reaches the 1-hour point. In addition, ED waiting room patients should be kept informed, offered comfort measures such analgesics, ice packs for painful injuries, and so on, and possibly diagnostic testing,
Conclusions
Patients leaving the emergency department without full evaluation are a significant problem in US emergency departments from both a health care and financial perspective. The triage nurse can potentially reduce this number through improved patient communication, attention to patient discomfort, and initiation of diagnostic testing. Younger patients are more likely to leave and do so just beyond the first hour of waiting.
Acknowledgment
The authors gratefully acknowledge Kristin Thomas, MA, Senior Research Specialist, Emig Research Center, York Hospital, Pa., for her participation in this project (statistical analysis).
Michele Johnson, Member, ENA Chapter 49, is Clinical Nurse, Department of Emergency Medicine, York Hospital, York, PA.
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Cited by (46)
Refusal of emergency medical care: An analysis of patients who left without being seen, eloped, and left against medical advice
2021, American Journal of Emergency MedicineCitation Excerpt :Patients who refused ED care cited three common reasons, including wait time, expectations not met, and negative interaction with ED staff. These findings confirm previous studies which found that a long wait time is the top reason patients LWBS [19–21]. ED wait times vary significantly and are related to triage acuity.
Characterization of emergency department abandonment using a real-time location system
2020, American Journal of Emergency MedicineCitation Excerpt :We used median wait times to make our analysis robust against outliers, especially the ones observed in the smaller ESI 2 population which skewed mean wait times in this group. Consistent with previous study findings were our average total LWBS rates of 1–3%, [3,13,16] as well as previous studies' findings of a discrepancy between actual abandonment times and traditional means of capturing this data. One study showed a discrepancy of roughly 25 min between the earliest recorded time a patient was noted to have left and the official end time of their medical chart [14]; this study shows an even larger gap, with a mean discrepancy of 92 (median 70) minutes between staff-recorded and RTLS departure time.
Fluid approximations and control of queues in emergency departments
2017, European Journal of Operational ResearchCitation Excerpt :The implication of this simplified assumption is that a patient (more generally a customer) can only abandon while in the queue, which is a common assumption in Erlang-A queueing systems (e.g. see Garnett et al., 2002; Hampshire et al., 2009; Rudolph, 2011). Although, in reality, patients can abandon the ED at any stage of the medical care process, including before triage (Johnson, Myers, Wineholt, Pollack, & Kusmiesz, 2009). The final modeling assumption relates to the medical care service process.
An agent-based model for quantitatively analyzing and predicting the complex behavior of emergency departments
2017, Journal of Computational ScienceA simulation and optimization based method for calibrating agent-based emergency department models under data scarcity
2017, Computers and Industrial EngineeringComparing patients who leave the ED prematurely, before vs after medical evaluation: A National Hospital Ambulatory Medical Care Survey analysis
2016, American Journal of Emergency MedicineCitation Excerpt :Increased rates of patients who leave before medical assessment are associated with high ED volumes and crowding (Weiss 2005 [7], Hobbs 2000 [15], McMullan 2004 [16]). Patients consistently identify wait times as a major reason for leaving before medical assessment (Rowe 2006 [3], McNamara 1995 [17], Johnson 2009 [18], Mohsin 2007 [19], Monzon 2005 [20], Arendt 2003 [21], Baker 1991 [2]). Conversely, high rates of patients leaving after provider assessment have not been shown to correlate with ED overcrowding (Ding 2007 [9]), and reasons for leaving prematurely have not been clearly identified in this group.
Michele Johnson, Member, ENA Chapter 49, is Clinical Nurse, Department of Emergency Medicine, York Hospital, York, PA.
Stephanie Myers, Member, ENA Chapter 49, is Clinical Nurse, Department of Emergency Medicine, York Hospital, York, PA.
June Wineholt, Member, ENA Chapter 49, is Clinical Nurse, Assistant Nurse Manager, Department of Emergency Medicine, York Hospital, York, PA.
Marc Pollack is Research Director, Department of Emergency Medicine, York Hospital, York, PA.
Amy L. Kusmiesz is Clinical Research Associate, Department of Emergency Medicine, York Hospital, York, PA.