Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan.
BMC Emerg Med. 2013 Jan 16;13:1. doi: 10.1186/1471-227X-13-1.
A patient left without being seen is a well-recognized indicator of Emergency Department overcrowding. The aim of this study was to define the characteristics of LWBS patients, their rates and associated factors from a tertiary care hospital of Pakistan.
A retrospective patient record review was undertaken. All patients presenting to the Aga Khan University Hospital, Karachi, between April and December of the year 2010, were included in the study. Information was collected on age, sex, presenting complaints, ED capacity, month, time, shift, day of the week, and waiting times in the ED. A basic descriptive analysis was made and the rates of LWBS patients were determined among the patient subgroups. Logistic regression analysis was used to assess the risk factors associated with a patient not being seen in the ED.
A total of 38,762 patients visited ED during the study period. Among them 5,086 (13%) patients left without being seen. Percentage of leaving was highest in the night shift (20%). The percentage was twice as high when the ED was on diversion (19.8%) compared to regular periods of operation (9.8%). Mean waiting time before leaving the ED in pediatric patients was 154 minutes while for adults it was 171 minutes. More than 32% of patients had waited for more than 180 minutes before they left without being seen, compared to the patients who were seen in ED. Important predictors for LWBS included; Triage category P4 i.e. walk -in-patients had an OR of 13.62(8.72-21.3), Diversion status, OR 1.49(1.26-1.76), night shift , OR 2.44(1.95-3.05) and Pediatric age, OR 0.57(0.48-0.66).
Our study elucidates the LWBS population characteristics and identifies the risk factors for this phenomenon. Targeted interventions should be planned and implemented to decrease the waiting time and alternate services should be provided for high-risk patients (for LWBS) to minimize their number.
未得到诊治就离开的患者是急诊科过度拥挤的一个公认指标。本研究旨在确定巴基斯坦一家三级护理医院的离开未诊治患者（LWBS）患者的特征、其发生率以及相关因素。
我们开展了一项回顾性病历审查。本研究纳入了 2010 年 4 月至 12 月期间在卡拉奇阿迦汗大学医院就诊的所有患者。收集的信息包括年龄、性别、就诊主诉、急诊科容量、月份、时间、班次、星期几和在急诊科的等候时间。我们进行了基本描述性分析，并确定了亚组患者中 LWBS 患者的发生率。我们采用 logistic 回归分析评估与患者未在急诊科接受诊治相关的风险因素。
在研究期间，共有 38762 名患者到急诊科就诊。其中 5086 名（13%）患者离开时未得到诊治。夜间班次的离开率最高（20%）。当急诊科分流（19.8%）时，离开率是常规运营期间（9.8%）的两倍。儿科患者离开急诊科前的平均等候时间为 154 分钟，而成人患者的平均等候时间为 171 分钟。与在急诊科接受诊治的患者相比，超过 32%的患者在离开前等候了 180 多分钟。LWBS 的重要预测因素包括：分类级别 P4，即门诊患者的 OR 为 13.62（8.72-21.3）、分流状态，OR 为 1.49（1.26-1.76）、夜班，OR 为 2.44（1.95-3.05）和儿科年龄，OR 为 0.57（0.48-0.66）。
我们的研究阐明了 LWBS 人群的特征，并确定了导致这种现象的风险因素。应计划和实施有针对性的干预措施，以减少等候时间，并应为高风险患者（LWBS）提供替代服务，以最大程度地减少其数量。
