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A comparative study of patient characteristics, opinions, and outcomes, for patients who leave the emergency department before medical assessment

  • Jacqueline Fraser (a1) (a2), Paul Atkinson (a2) (a3) (a4), Audra Gedmintas (a1) (a2), Michael Howlett (a1) (a2) (a4), Rose McCloskey (a1) (a2) (a3) and James French (a1) (a2) (a4)...

Abstract

Objective

The emergency department (ED) left-without-being-seen (LWBS) rate is a performance indicator, although there is limited knowledge about why people leave, or whether they seek alternate care. We studied characteristics of ED LWBS patients to determine factors associated with LWBS.

Methods

We collected demographic data on LWBS patients at two urban hospitals. Sequential LWBS patients were contacted and surveyed using a standardized telephone survey. A matched group of patients who did not leave were also surveyed. Data were analysed using the Fisher exact test, chi-square test, and student t-test.

Results

The LWBS group (n=1508) and control group (n=1504) were matched for sex, triage category, recorded wait times, employment and education, and having a family physician. LWBS patients were younger, more likely to present in the evening or at night, and lived closer to the hospital. A long wait time was the most cited reason for leaving (79%); concern about medical condition was the most common reason for staying (96%). Top responses for improved likelihood of waiting were shorter wait times (LWBS, 66%; control, 31%) and more information on wait times (41%; 23%). A majority in both groups felt that their condition was a true emergency (63%; 72%). LWBS patients were more likely to seek further health care (63% v. 28%; p<0.001) and sooner (median time 1 day v. 2-4 days; p=0.002). Among patients who felt that their condition was not a true emergency, the top reason for ED attendance was the inability to see their family doctor (62% in both groups).

Conclusion

LWBS patients had similar opinions, experiences, and expectations as control patients. The main reason for LWBS was waiting longer than expected. LWBS patients were more likely to seek further health care, and did so sooner. Patients wait because of concern about their health problem. Shorter wait times and improved communication may reduce the LWBS rate.

Contexte

Le taux de départ sans examen médical (DSEM) au service des urgences (SU) est un indicateur de performance, mais on en connaît bien peu sur les raisons qui poussent les patients à partir ou sur la recherche ou non de formules de rechange. L’étude visait donc à caractériser les malades qui partent sans avoir été examinés afin de déterminer les facteurs associés au phénomène.

Méthode

Il y a eu collecte de données démographiques sur les malades qui sont partis sans avoir été examinés dans deux hôpitaux urbains. On a communiqué avec ceux-ci en ordre séquentiel et l’on a procédé à une enquête téléphonique à l’aide d’un questionnaire uniforme. Par ailleurs, un groupe apparié de patients qui sont restés au SU ont également été soumis à l’enquête. Les données recueillies ont été analysées à l’aide de la méthode exacte de Fisher, du test du chi carré et du test de Student.

Résultats

Le groupe de DSEM (n=1508) et le groupe témoin (n=1504) ont été appariés en fonction du sexe, de la catégorie de triage, du temps d’attente enregistré, de l’emploi, du degré d’instruction et de la possibilité ou non de consulter un médecin de famille. Les patients du groupe de DSEM étaient plus jeunes que ceux de l’autre groupe et plus susceptibles de consulter le soir ou la nuit et de demeurer près de l’hôpital. Le motif de départ invoqué le plus souvent était un délai d’attente trop long (79 %); le motif d’attente invoqué le plus souvent était l’inquiétude causée par la gravité de l’affection (96 %). Les réponses mentionnées le plus souvent pour améliorer les probabilités d’attente au SU étaient une réduction des délais d’attente (DSEM : 66 %; témoin : 31 %) et plus de renseignements sur les délais d’attente (41 %; 23 %). Dans les deux groupes, la majorité des participants estimaient qu’il s’agissait d’une véritable urgence (63 %; 72 %). Les patients du groupe de DSEM avaient tendance à rechercher une formule de rechange (63 % contre [c.] 28 %; p<0,001), et ce, plus rapidement que ceux de l’autre groupe (temps médian : 1 jour c. 2-4; p=0,002). Parmi les patients qui estimaient que leurs ennuis de santé n’étaient pas une véritable urgence, la principale raison invoquée pour consulter au SU était l’impossibilité de voir un médecin de famille (62 % dans les deux groupes).

Conclusions

Les patients du groupe de DSEM avaient en commun les mêmes opinions, les mêmes expériences et les mêmes attentes que les témoins. Le principal motif invoqué par les patients du groupe de DSEM était un délai d’attente plus long que prévu. Par ailleurs, ces mêmes personnes étaient plus susceptibles de rechercher une formule de rechange de soins, et ce, plus rapidement que les témoins. Quant aux patients de l’autre groupe, ils attendaient en raison de l’inquiétude causée par leur affection. Des délais d’attente plus courts et de meilleures communications pourraient permettre une diminution du taux de DSEM.

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Copyright

Corresponding author

Correspondence to: Paul Atkinson, Department of Emergency Medicine, Dalhousie University, Horizon Health Network, Saint John Regional Hospital, 400 University Avenue, Saint John, NB E2L 4L2; Email: Paul.atkinson@dal.ca

References

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Keywords

A comparative study of patient characteristics, opinions, and outcomes, for patients who leave the emergency department before medical assessment

  • Jacqueline Fraser (a1) (a2), Paul Atkinson (a2) (a3) (a4), Audra Gedmintas (a1) (a2), Michael Howlett (a1) (a2) (a4), Rose McCloskey (a1) (a2) (a3) and James French (a1) (a2) (a4)...

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