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Return visit characteristics among patients who leave without being seen from a pediatric ED

Published:October 26, 2011DOI:https://doi.org/10.1016/j.ajem.2011.06.017

      Abstract

      Objectives

      The primary aim of this study was to evaluate for differences in acuity level and rate of admission on return visit between patients who leave without being seen (LWBS) and those who are initially evaluated by a physician. Our secondary aim was as well as to identify predictors of which LWBS patients will return to the ED with high acuity or require admission.

      Methods

      A cross-sectional study using an administrative database at an academic tertiary-care pediatric hospital in the United States from January 1, 2006, to December 31, 2008 was done.

      Results

      There were 3525 patients who LWBS during the study period (1.2% of total ED visits). Of these, 87% were triaged as nonurgent, and 13% as urgent at their initial visit. Two hundred eighty-nine (8%) of LWBS patients returned to the ED within 48 hours. Compared with the population who returned to the ED after previous evaluation, patients who LWBS from their initial visit and returned had significantly lower odds of urgent acuity at time of return visit (odds ratio [OR], 0.22; 95% confidence interval [CI], 0.15-0.32) and of being admitted (OR, 0.58; 95% CI, 0.40-0.84). Urgent acuity at initial visit (OR, 2.86; 95% CI, 1.35-6.04) and number of ED visits in last 6 months (OR, 1.24; 95% CI, 1.02-1.52) were significant predictors of admission at return visit among the LWBS population.

      Conclusions

      Generally, patients who LWBS from a pediatric ED were unlikely to return for ED care, and those who did were unlikely to either be triaged as urgent or require hospital admission. This study showed that urgent acuity during the initial visit and number of previous ED visits were significant predictors of admission on return. Identification of these predictors may allow a targeted intervention to ensure follow-up of patients who meet these criteria after they LWBS from the pediatric ED.
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      References

      1. National Healthcare Quality Report, 2009. AHRQ Publication No. 10-0003, 2010. (Accessed February 22, 2011, at http://www.ahrq.gov/qual/qrdr09.htm.)

        • Baker D.W.
        • Stevens C.D.
        • Brook R.H.
        Patients who leave a public hospital emergency department without being seen by a physician. Causes and consequences.
        JAMA. 1991; 266: 1085-1090
        • Fernandes C.M.
        • Daya M.R.
        • Barry S.
        • Palmer N.
        Emergency department patients who leave without seeing a physician: the Toronto Hospital experience.
        Ann Emerg Med. 1994; 24: 1092-1096
        • Arendt K.W.
        • Sadosty A.T.
        • Weaver A.L.
        • Brent C.R.
        • Boie E.T.
        The left-without-being-seen patients: what would keep them from leaving?.
        Ann Emerg Med. 2003; 42: 317-323
        • Hobbs D.
        • Kunzman S.C.
        • Tandberg D.
        • Sklar D.
        Hospital factors associated with emergency center patients leaving without being seen.
        Am J Emerg Med. 2000; 18: 767-772
        • Kronfol R.N.
        • Childers K.
        • Caviness A.C.
        Patients who leave our emergency department without being seen: the Texas Children's Hospital experience.
        Pediatr Emerg Care. 2006; 22: 550-554
        • Bourgeois F.T.
        • Shannon M.W.
        • Stack A.M.
        “Left without being seen”: a national profile of children who leave the emergency department before evaluation.
        Ann Emerg Med. 2008; 52: 599-605
        • Browne G.J.
        • McCaskill M.E.
        • Giles H.
        • Lam L.T.
        • Fasher B.J.
        • Exley B.
        Paediatric walk-out patients: characteristics and outcomes.
        J Paediatr Child Health. 2001; 37: 235-239
        • dos Santos L.M.
        • Stewart G.
        • Rosenberg N.M.
        Pediatric emergency department walk-outs.
        Pediatr Emerg Care. 1994; 10: 76-78
        • Goldman R.D.
        • Macpherson A.
        • Schuh S.
        • Mulligan C.
        • Pirie J.
        Patients who leave the pediatric emergency department without being seen: a case-control study.
        CMAJ. 2005; 172: 39-43
        • Dershewitz R.A.
        • Paichel W.
        Patients who leave a pediatric emergency department without treatment.
        Ann Emerg Med. 1986; 15: 717-720
      2. Welch SJ, Asplin BR, Stone-Griffith S, Davidson SJ, Augustine J, Schuur J. Emergency Department Operational Metrics, Measures and Definitions: Results of the Second Performance Measures and Benchmarking Summit. Ann Emerg Med.

        • Elashoff J.D.
        nQuery Advisor Version 7.0. Statistical Solutions, Inc, Cork, Ireland2007
      3. Timm NL, Ruddy RM. Demographics of patient visits during high daily census in a pediatric ED. Am J Emerg Med;28:56-60.

      4. Gaucher N, Bailey B, Gravel J. Who are the children leaving the emergency department without being seen by a physician? Acad Emerg Med;18:152-7.

        • Mohsin M.
        • Young L.
        • Ieraci S.
        • Bauman A.E.
        Factors associated with walkout of patients from New South Wales hospital emergency departments, Australia.
        Emerg Med Australas. 2005; 17: 434-442
        • Ruger J.P.
        • Richter C.J.
        • Spitznagel E.L.
        • Lewis L.M.
        Analysis of costs, length of stay, and utilization of emergency department services by frequent users: implications for health policy.
        Acad Emerg Med. 2004; 11: 1311-1317
        • Ding R.
        • McCarthy M.L.
        • Li G.
        • Kirsch T.D.
        • Jung J.J.
        • Kelen G.D.
        Patients who leave without being seen: their characteristics and history of emergency department use.
        Ann Emerg Med. 2006; 48: 686-693
        • McMullan J.T.
        • Veser F.H.
        Emergency department volume and acuity as factors in patients leaving without treatment.
        South Med J. 2004; 97: 729-733
        • Polevoi S.K.
        • Quinn J.V.
        • Kramer N.R.
        Factors associated with patients who leave without being seen.
        Acad Emerg Med. 2005; 12: 232-236
        • Timm N.L.
        • Ho M.L.
        • Luria J.W.
        Pediatric emergency department overcrowding and impact on patient flow outcomes.
        Acad Emerg Med. 2008; 15: 832-837
        • Goodacre S.
        • Webster A.
        Who waits longest in the emergency department and who leaves without being seen?.
        Emerg Med J. 2005; 22: 93-96
        • Kennedy J.
        • Rhodes K.
        • Walls C.A.
        • Asplin B.R.
        Access to emergency care: restricted by long waiting times and cost and coverage concerns.
        Ann Emerg Med. 2004; 43: 567-573