Faculty of Nursing, University of New Brunswick, Fredericton, New Brunswick, Canada.
Dr. Everett Chalmers Regional Hospital, Fredericton, New Brunswick, Canada.
Int Emerg Nurs. 2023 Sep;70:101349. doi: 10.1016/j.ienj.2023.101349. Epub 2023 Sep 12.
People who present to an emergency department but leave before seeing a medical practitioner (LWBS) pose a potential risk, especially those triaged with higher acuity care needs.
To describe and compare characteristics of emergency patients who LWBS by triage acuity.
Retrospective review of administrative data for a 1-year period. Chi-square and logistic regression analyses conducted to investigate differences in characteristics specific to individual and the timing of presentation between patients who LWBS and were triaged as higher acuity compared to those who left but were triaged as less- or non-urgent.
During study period, 12.6 % of patients LWBS with 30.0 % of these cases triaged as higher acuity. Number triaged as higher acuity who LWBS tended to be higher during days with a higher volume of higher acuity cases. The likelihood of LWBS for those triaged as higher acuity was higher among older age groups and those with a primary care provider who presented on weekdays, during evening and night shifts, and in the winter months.
Findings highlight differences in LWBS cases by triage acuity and raise questions about emergency nurses' professional responsibility to follow-up with those who LWBS if they have been triaged as higher acuity based on an assessment of their presenting complaint and risk for complications or deterioration. While continuing to work to reduce wait times and improve patient flow, it is important to identify factors affecting patients' decision to LWBS, especially for those triaged with higher acuity healthcare needs.
到急诊科就诊但在见到医生前离开的患者（LWBS）存在潜在风险，尤其是那些被分诊为更高 acuity care needs 的患者。
描述并比较根据分诊 acuity 离开但未就诊的急诊患者的特征。
对为期 1 年的行政数据进行回顾性分析。进行卡方检验和 logistic 回归分析，以调查个体特征和就诊时间在 LWBS 患者和分诊为更高 acuity 但离开且分诊为不太紧急或非紧急患者之间的差异。
在研究期间，12.6%的患者 LWBS，其中 30.0%的患者分诊为更高 acuity。分诊为更高 acuity 且 LWBS 的患者数量在更高 acuity 病例数量较高的日子里趋于更高。在工作日、傍晚和夜间轮班以及冬季，分诊为更高 acuity 的患者年龄较大，有初级保健提供者，且更有可能 LWBS。
研究结果突出了根据分诊 acuity 进行 LWBS 的差异，并提出了一些问题，即如果根据对患者就诊主诉和并发症或恶化风险的评估将其分诊为更高 acuity，急诊护士是否有责任对 LWBS 的患者进行随访。在继续努力减少等待时间和改善患者流量的同时，重要的是要确定影响患者 LWBS 决策的因素，特别是对于那些分诊为更高 acuity 医疗需求的患者。
