Abstract
Objective
Emergency department (ED) patients may elect to refuse any aspect of medical care.
They may leave prior to physician evaluation, elope during treatment, or leave against
medical advice during treatment. This study was undertaken to identify patient perspectives
and reasons for refusal of care.
Methods
This prospective study was conducted at an urban Level 1 Trauma Center. This study
examined ED patients who left without being seen (LWBS), eloped during treatment,
or left against medical advice during September to December 2018. This project included
both chart review and a prospective patient survey.
Results
Among 298 participants, the majority were female (54%). Most participants were White
(61%) or African American (36%). Thirty-eight percent of participants left against
medical advice, 23% eloped, and 39% left without being seen by a provider. When compared
to the general ED population, patients who refused care were significantly younger
(p < 0.001). When comparing by groups, patients who left AMA were significantly older
than those who eloped or left without being seen (p < 0.001). Among 68 patients interviewed
by telephone, the most common stated reasons for refusal of care included wait time
(23%), unmet expectations (23%), and negative interactions with ED staff (15%).
Conclusion
ED patients who refused care were significantly younger than the general ED population.
Common reasons cited by patients for refusal of care included wait time, unmet expectations,
and negative interactions with ED staff.
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Article Info
Publication History
Published online: October 23, 2019
Accepted:
September 27,
2019
Received in revised form:
September 26,
2019
Received:
July 26,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
