Patients who present to the emergency department and leave without being seen

Abstract

To identify the prevalence, predictors and outcomes of patients who leave without being seen (LWBS) in one hospital emergency department (ED). A descriptive, retrospective cohort study design was used. Data were extracted from the ED Information System. Multivariate logistic regression identified independent predictors of patients who LWBS. Two main outcomes were studied: the proportion of patients who waited longer than recommended and the proportion of patients who represented to the ED within 72 h. A large regional teaching hospital ED in South East Queensland, Australia. A total of 64 292 patient presentations made to the ED from 9 August 2008 to 8 August 2009. The prevalence of patients who LWBS was 10.7%. Independent predictors of LWBS included younger age, lower urgency triage category allocation, arrival by means other than ambulance, evening and night shift presentations, winter season, weekend presentations and presenting complaint category of 'gastrointestinal' or 'paediatric'. When compared with patients who waited, those who LWBS comprised higher proportions of waiting longer than recommended (LWBS: 77.2% vs. waited: 52.0%, P<0.001) and higher proportions of representations to ED within 72 h (LWBS: 10.3% vs. waited: 5.4%, P<0.001). Outcomes investigated in this study indicate that room for improvement exists not only for patients who LWBS but all patients presenting to the ED. The most powerful predictors of LWBS were lower urgency triage allocation and evening and night shift presentations. This suggests that service improvements could be targeted during 'out of business hours' for those with less emergent conditions.