Fraser Jacqueline, Atkinson Paul, Gedmintas Audra, Howlett Michael, McCloskey Rose, French James
*Department of Emergency Medicine,Dalhousie University,Saint John,NB.
†Horizon Health Network,Saint John Regional Hospital,Saint John,NB.
CJEM. 2017 Sep;19(5):347-354. doi: 10.1017/cem.2016.375. Epub 2016 Oct 3.
The emergency department (ED) left-without-being-seen (LWBS) rate is a performance indicator, although there is limited knowledge about why people leave, or whether they seek alternate care. We studied characteristics of ED LWBS patients to determine factors associated with LWBS.
We collected demographic data on LWBS patients at two urban hospitals. Sequential LWBS patients were contacted and surveyed using a standardized telephone survey. A matched group of patients who did not leave were also surveyed. Data were analysed using the Fisher exact test, chi-square test, and student t-test.
The LWBS group (n=1508) and control group (n=1504) were matched for sex, triage category, recorded wait times, employment and education, and having a family physician. LWBS patients were younger, more likely to present in the evening or at night, and lived closer to the hospital. A long wait time was the most cited reason for leaving (79%); concern about medical condition was the most common reason for staying (96%). Top responses for improved likelihood of waiting were shorter wait times (LWBS, 66%; control, 31%) and more information on wait times (41%; 23%). A majority in both groups felt that their condition was a true emergency (63%; 72%). LWBS patients were more likely to seek further health care (63% v. 28%; p<0.001) and sooner (median time 1 day v. 2-4 days; p=0.002). Among patients who felt that their condition was not a true emergency, the top reason for ED attendance was the inability to see their family doctor (62% in both groups).
LWBS patients had similar opinions, experiences, and expectations as control patients. The main reason for LWBS was waiting longer than expected. LWBS patients were more likely to seek further health care, and did so sooner. Patients wait because of concern about their health problem. Shorter wait times and improved communication may reduce the LWBS rate.
急诊科未就诊即离开（LWBS）率是一项绩效指标，不过对于人们离开的原因，或者他们是否寻求其他医疗服务，我们了解得还很有限。我们研究了急诊科LWBS患者的特征，以确定与LWBS相关的因素。
我们收集了两家城市医院LWBS患者的人口统计学数据。通过标准化电话调查对连续的LWBS患者进行联系和调查。还对一组未离开的匹配患者进行了调查。数据采用Fisher精确检验、卡方检验和学生t检验进行分析。
LWBS组（n = 1508）和对照组（n = 1504）在性别、分诊类别、记录的等待时间、就业和教育情况以及是否有家庭医生方面进行了匹配。LWBS患者更年轻，更有可能在晚上或夜间就诊，并且住得离医院更近。等待时间过长是最常被提及的离开原因（79%）；对病情的担忧是最常见的留下原因（96%）。对于提高等待可能性的首要反馈是等待时间缩短（LWBS组为66%；对照组为31%）以及关于等待时间的更多信息（41%；23%）。两组中的大多数人都认为自己的病情是真正的紧急情况（63%；72%）。LWBS患者更有可能寻求进一步的医疗服务（63%对28%；p<0.001），并且寻求的时间更早（中位时间为1天对2 - 4天；p = 0.002）。在那些认为自己的病情不是真正紧急情况的患者中，前往急诊科就诊的首要原因是无法看自己的家庭医生（两组均为62%）。
LWBS患者与对照患者有相似的意见、经历和期望。LWBS的主要原因是等待时间比预期长。LWBS患者更有可能寻求进一步的医疗服务，并且寻求的时间更早。患者因为对自身健康问题的担忧而等待。缩短等待时间和改善沟通可能会降低LWBS率。
