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

QUESTIONS UNDER STUDY

To describe characteristics of patients leaving the emergency department (ED) before being seen by a physician and to identify factors associated with a greater risk of leaving the ED too early.

DESIGN

retrospective database analysis.

SETTING

emergency department (ED) of an urban teaching hospital admitting 60,000 patients per year.

STUDY SUBJECTS

all patients older than 18 years admitted to the ED over one year. Collected data: patient's and ED visit characteristics.

RESULTS

Among the 57,645 patients admitted, we identified 2,413 patients (4.2%) who left without being seen (LWBS). LWBS patients were more likely to be male (odds ratio [OR] 1.13, 95% confidence interval [CI 95%]: 1.03-1.23), single (OR 1.12, CI 95%: 1.01-1.23), unemployed (OR 1.27, CI 95%: 1.13-1.44), dependent on welfare (OR 1.29, CI 95%: 1.12-1.50) or Muslim (OR 1.19, CI 95%: 1.00-1.42). LWBS patients were also more likely to present with less acute emergency triage levels. As complaints, alcohol and/or other substance abuse (OR 6.08, CI 95%: 5.04-7.34), neurological problems (OR 2.23, CI 95%: 1.88-2.64) or dermatological problems (OR 1.63, CI 95%: 1.37-1.94) were over-represented in this population. Patients admitted at week-ends (OR 1.27, 95% CI: 1.16-1.39) and/or during the night (OR = 2.67, 95% C: 2.35-3.02) also were at higher risk of leaving the ED prematurely.

CONCLUSIONS

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.