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Patients who leave without being seen in emergency departments: an analysis of predictive factors and outcomes.
Acad Emerg Med. 2012 Apr; 19(4):439-47.AE

Abstract

OBJECTIVES

The objective was to identify predictive factors and outcomes associated with patients who leave emergency departments (EDs) without being seen in Victoria, Australia.

METHODS

This was a retrospective observational study of Victorian ED patient visits between July 1, 2000, and June 30, 2005, using linked hospital, ED, and death registration data. Index ED visits were identified for patients who left without being seen (LWBS) and for those who completed ED treatment and were discharged home. Statistical analyses included a general description and univariate analysis of patient, ED visit, temporal, and hospital-level factors. Logistic regression models were developed to assess risk factors associated with LWBS status compared to patients who completed treatment, to assess 48 hour re-presentations to ED; 48-hour hospital admissions; and 2-,7-, and 30-day mortality among those who LWBS compared to those who completed treatment. Adjusted odds ratios (ORs) and 99% confidence intervals (CIs) are presented.

RESULTS

There were 239,305 LWBS episodes, for 205,500 patients over the 5-year period. Independent factors associated with LWBS patients in comparison to those who completed treatment include patients who are younger (15 to 24 years, OR = 2.46, 99% CI = 2.37 to 2.56), male (OR = 1.07, 99% CI = 1.05 to 1.08), of Australian indigenous background (OR = 1.63, 99% CI = 1.53 to 1.73), of non-English-speaking background (OR = 1.08, 99% CI = 1.06 to 1.10), noncompensable status (OR = 1.73, 99% CI = 1.68 to 1.79), self-referring (OR = 1.46, 99% CI = 1.43 to 1.49), nonassisted arrival mode (OR = 1.35, 99% CI = 1.30 to 1.40), and those with a hospital admission in the 12 months before the ED presentation (OR = 1.53, 99% CI = 1.51 to 1.55). Patients who LWBS had triage categories of lower urgency (nonurgent, OR = 8.21, 99% CI = 8.00 to 8.43), attended during the evening (OR = 1.10, 99% CI = 1.08 to 1.12), on either Sunday (OR = 1.20, 99% CI = 1.18 to 1.23) or Monday (OR = 1.20, 99% CI = 1.17 to 1.23), in winter (OR = 1.14, 99% CI = 1.12 to 1.16), with higher rates occurring in higher volume EDs (OR = 2.20, 99% CI = 2.15 to 2.26). There was no greater risk of mortality for LWBS patients compared to patients who completed treatment. The risk of hospital admission within 48 hours of discharge was lower for LWBS patients (OR = 0.60, 99% CI = 0.58 to 0.62); however, ED re-presentation risk was higher (OR = 1.63, 99% CI = 1.60 to 1.67).

CONCLUSIONS

Patients who leave EDs in Victoria, Australia, without being seen are at lower risk of hospital admission and at no greater risk of mortality, but are at higher risk of re-presenting to an ED compared to patients who complete treatment and are discharged home.

Authors+Show Affiliations

Centre for Clinical Epidemiology, Biostatistics and Health Services Research, the University of Melbourne, Australia. joanne.tropea@mh.org.auNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22506948

Citation

Tropea, Joanne, et al. "Patients Who Leave Without Being Seen in Emergency Departments: an Analysis of Predictive Factors and Outcomes." Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, vol. 19, no. 4, 2012, pp. 439-47.
Tropea J, Sundararajan V, Gorelik A, et al. Patients who leave without being seen in emergency departments: an analysis of predictive factors and outcomes. Acad Emerg Med. 2012;19(4):439-47.
Tropea, J., Sundararajan, V., Gorelik, A., Kennedy, M., Cameron, P., & Brand, C. A. (2012). Patients who leave without being seen in emergency departments: an analysis of predictive factors and outcomes. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 19(4), 439-47. https://doi.org/10.1111/j.1553-2712.2012.01327.x
Tropea J, et al. Patients Who Leave Without Being Seen in Emergency Departments: an Analysis of Predictive Factors and Outcomes. Acad Emerg Med. 2012;19(4):439-47. PubMed PMID: 22506948.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patients who leave without being seen in emergency departments: an analysis of predictive factors and outcomes. AU - Tropea,Joanne, AU - Sundararajan,Vijaya, AU - Gorelik,Alexandra, AU - Kennedy,Marcus, AU - Cameron,Peter, AU - Brand,Caroline A, PY - 2012/4/18/entrez PY - 2012/4/18/pubmed PY - 2012/8/14/medline SP - 439 EP - 47 JF - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine JO - Acad Emerg Med VL - 19 IS - 4 N2 - OBJECTIVES: The objective was to identify predictive factors and outcomes associated with patients who leave emergency departments (EDs) without being seen in Victoria, Australia. METHODS: This was a retrospective observational study of Victorian ED patient visits between July 1, 2000, and June 30, 2005, using linked hospital, ED, and death registration data. Index ED visits were identified for patients who left without being seen (LWBS) and for those who completed ED treatment and were discharged home. Statistical analyses included a general description and univariate analysis of patient, ED visit, temporal, and hospital-level factors. Logistic regression models were developed to assess risk factors associated with LWBS status compared to patients who completed treatment, to assess 48 hour re-presentations to ED; 48-hour hospital admissions; and 2-,7-, and 30-day mortality among those who LWBS compared to those who completed treatment. Adjusted odds ratios (ORs) and 99% confidence intervals (CIs) are presented. RESULTS: There were 239,305 LWBS episodes, for 205,500 patients over the 5-year period. Independent factors associated with LWBS patients in comparison to those who completed treatment include patients who are younger (15 to 24 years, OR = 2.46, 99% CI = 2.37 to 2.56), male (OR = 1.07, 99% CI = 1.05 to 1.08), of Australian indigenous background (OR = 1.63, 99% CI = 1.53 to 1.73), of non-English-speaking background (OR = 1.08, 99% CI = 1.06 to 1.10), noncompensable status (OR = 1.73, 99% CI = 1.68 to 1.79), self-referring (OR = 1.46, 99% CI = 1.43 to 1.49), nonassisted arrival mode (OR = 1.35, 99% CI = 1.30 to 1.40), and those with a hospital admission in the 12 months before the ED presentation (OR = 1.53, 99% CI = 1.51 to 1.55). Patients who LWBS had triage categories of lower urgency (nonurgent, OR = 8.21, 99% CI = 8.00 to 8.43), attended during the evening (OR = 1.10, 99% CI = 1.08 to 1.12), on either Sunday (OR = 1.20, 99% CI = 1.18 to 1.23) or Monday (OR = 1.20, 99% CI = 1.17 to 1.23), in winter (OR = 1.14, 99% CI = 1.12 to 1.16), with higher rates occurring in higher volume EDs (OR = 2.20, 99% CI = 2.15 to 2.26). There was no greater risk of mortality for LWBS patients compared to patients who completed treatment. The risk of hospital admission within 48 hours of discharge was lower for LWBS patients (OR = 0.60, 99% CI = 0.58 to 0.62); however, ED re-presentation risk was higher (OR = 1.63, 99% CI = 1.60 to 1.67). CONCLUSIONS: Patients who leave EDs in Victoria, Australia, without being seen are at lower risk of hospital admission and at no greater risk of mortality, but are at higher risk of re-presenting to an ED compared to patients who complete treatment and are discharged home. SN - 1553-2712 UR - https://www.unboundmedicine.com/medline/citation/22506948/Patients_who_leave_without_being_seen_in_emergency_departments:_an_analysis_of_predictive_factors_and_outcomes_ L2 - https://doi.org/10.1111/j.1553-2712.2012.01327.x DB - PRIME DP - Unbound Medicine ER -