Wartman S A, Taggart M P, Palm E
J Community Health. 1984 Summer;9(4):261-8. doi: 10.1007/BF01338726.
Emergency rooms are used frequently by patients who do not require urgent treatment. Furthermore, a small but sizable number of these patients in busy emergency rooms leave (walk out) before they are actually examined by medical personnel. Data were analyzed for all patients presenting to a university-affiliated hospital emergency room during a one-year period. Six hundred forty-four persons left the emergency room before being seen (leavers). Based on a code routinely assigned to their presenting complaint, patients were divided into urgent and nonurgent categories. A random sample of 100 leavers was matched with nonurgent stayers by age, sex, race, and shift of presentation. Information was collected from medical records and telephone interviews. A multiple discriminant analysis revealed the following profile of the leaver: a person who lives within 21/2 miles of the hospital has either Medicare/caid or no medical insurance, has no private physician, and has a nonserious presenting complaint. Stayers, on the other hand, have more serious complaints, tend to have medical insurance, more often have a private physician, and may live at any distance from the hospital. In addition, leavers presented with drug, alcohol, or psychiatric problems more frequently than stayers. Leavers, on the average, spend 90 minutes waiting for treatment they never receive. This study characterizes a small but problematic subgroup for emergency department planners and suggests the need for community-based health education and referral of such patients to primary care centers.
不需要紧急治疗的患者经常使用急诊室。此外，在繁忙的急诊室中，有一小部分但数量可观的此类患者在医务人员实际检查之前就离开了（自行离开）。对一所大学附属医院急诊室在一年期间接待的所有患者的数据进行了分析。644人在就诊前离开了急诊室（离开者）。根据常规分配给他们就诊主诉的代码，患者被分为紧急和非紧急两类。通过年龄、性别、种族和就诊班次，从离开者中随机抽取100人与非紧急留观者进行匹配。信息从病历和电话访谈中收集。多元判别分析揭示了离开者的以下特征：居住在距医院2.5英里以内、拥有医疗保险/医疗补助或没有医疗保险、没有私人医生且就诊主诉不严重的人。另一方面，留观者有更严重的主诉，往往有医疗保险，更常拥有私人医生，并且可能居住在距医院任何距离的地方。此外，离开者出现药物、酒精或精神问题的频率比留观者更高。离开者平均花费90分钟等待他们从未接受的治疗。这项研究为急诊科规划者刻画了一个虽小但有问题的亚组，并表明需要开展基于社区的健康教育以及将此类患者转诊至初级保健中心。
