Emergency Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
Emerg Med Australas. 2023 Feb;35(1):74-81. doi: 10.1111/1742-6723.14057. Epub 2022 Aug 30.
Using a strength-based framework, we aimed to describe and compare First Nations patients who completed care in an ED to those who took their own leave.
Routinely collected adult patient data from a metropolitan ED collected over a 5-year period were analysed.
A total of 6446 presentations of First Nations patients occurred from 2016 to 2020, constituting 3% of ED presentations. Of these, 5589 (87%) patients waited to be seen and 857 (13%) took their own leave. Among patients who took their own leave, 624 (73%) left not seen and 233 (27%) left at own risk after starting treatment. Patients who were assigned a triage category of 4-5 were significantly more likely to take their own leave (adjusted odds ratio [OR] 3.17, 95% confidence interval [CI] 2.67-3.77, P < 0.001). Patients were significantly less likely to take their own leave if they were >60 years (adjusted OR 0.69, 95% CI 1.01-1.36, P = 0.014) and had private health insurance (adjusted OR 0.61, 95% CI 0.45-0.84, P < 0.001). Patients were more likely to leave if they were women (adjusted OR 1.17, 95% CI 1.01-1.36, P = 0.04), had an unknown housing status (adjusted OR 1.76, 95% CI 1.44-2.15, P < 0.001), were homeless (adjusted OR 1.50, 95% CI 1.22-1.93, P < 0.001) or had a safety alert (adjusted OR 1.60, 95% CI 1.35-1.90, P < 0.001).
A lower triage category is a strong predictor of First Nations patients taking their own leave. It has been documented that First Nations patients are under-triaged. One proposed intervention in the metropolitan setting is to introduce practices which expediate the care of First Nations patients. Further qualitative studies with First Nations patients should be undertaken to determine successful approaches to create equitable access to emergency healthcare for this population.
我们采用基于优势的框架，旨在描述和比较在急诊完成治疗的原住民患者和自行离开的患者。
对 5 年内某都市急诊的成年患者常规收集的数据进行分析。
2016 年至 2020 年期间，共有 6446 例原住民患者就诊，占急诊就诊人数的 3%。其中，5589 名（87%）患者等待就诊，857 名（13%）自行离开。在自行离开的患者中，有 624 名（73%）未被诊治，233 名（27%）在开始治疗后自行离开。分诊类别为 4-5 的患者更有可能自行离开（校正优势比[OR]3.17，95%置信区间[CI]2.67-3.77，P<0.001）。年龄>60 岁（校正 OR 0.69，95%CI 1.01-1.36，P=0.014）和有私人医疗保险（校正 OR 0.61，95%CI 0.45-0.84，P<0.001）的患者不太可能自行离开。女性（校正 OR 1.17，95%CI 1.01-1.36，P=0.04）、无住房状况（校正 OR 1.76，95%CI 1.44-2.15，P<0.001）、无家可归（校正 OR 1.50，95%CI 1.22-1.93，P<0.001）或有安全警报（校正 OR 1.60，95%CI 1.35-1.90，P<0.001）的患者更有可能自行离开。
较低的分诊类别是原住民患者自行离开的一个强有力的预测因素。已记录到原住民患者分诊不足。在大都市环境中，一种拟议的干预措施是引入加快原住民患者治疗的措施。应进一步对原住民患者进行定性研究，以确定为这一人群提供公平获得急诊医疗服务的成功方法。
