Patients who leave emergency departments without being seen by a physician: magnitude of the problem in Los Angeles County.

STUDY OBJECTIVES

To determine the hospital characteristics associated with patients leaving emergency departments prior to physician evaluation.

DESIGN

Cross-sectional design with data collection by mail and telephone survey.

SETTING

Los Angeles County, California.

TYPE OF PARTICIPANTS

Convenience sample of four public and 26 private hospital EDs with a combined monthly volume of 92,570.

INTERVENTIONS

None.

RESULTS

Questionnaires were returned from 83% of EDs surveyed. During 1990, 4.2% of patients at these EDs left without being seen by a physician. In all, 7.3% of public hospital patients left without being seen, and 2.4% of private hospital patients left without being seen (P < .001). The percentage of patients who left without being seen was significantly higher at EDs with longer waiting times, higher fraction of uninsured patients, and at hospitals with accredited residency training programs (P < .001 for each comparison). A logistic regression model, used to simultaneously evaluate the effects of multiple correlated factors, revealed that waiting time, fraction of patients uninsured, and teaching status had independent positive associations with patients who left without being seen.

CONCLUSION

More than 4% of patients who seek care at EDs in Los Angeles County leave without being seen by a physician. A greater proportion of patients leave without medical evaluation from EDs with long waiting times for ambulatory patients and from those that serve uninsured populations. These findings should be interpreted in light of existing data on the health consequences faced by patients who leave hospital EDs without treatment.