Skip to main content Accessibility help
×
Home

Étude des facteurs hospitaliers associés aux départs avant prise en charge médicale à l’urgence d’un centre hospitalier de soins tertiaires

  • Nicolas Elazhary (a1) (a2), Marie-Laure Dolbec (a3), Thierry Boucher (a3), Jean-François Deshaies (a1), Alain Vanasse (a1) (a2) and René Beaudoin (a1)...

Résumé

Objectif

L’objectif de cette étude rétrospective était d’identifier les facteurs associés aux décomptes quotidiens de départs avant prise en charge médicale (DAPCM) dans les deux salles d’urgence du Centre hospitalier universitaire de Sherbrooke, Fleurimont (HF) et Hôtel-Dieu (HD).

Méthode

Des données cliniques et démographiques anonymisées, ainsi que des données hospitalières, ont été extraites de la banque de données du Centre Informatisé de Recherche Évaluative en Services et Soins de Santé pour la période du 1er avril 2011 au 30 juin 2012. Les variables étant corrélées au nombre de DAPCM par jour par site lors des analyses univariées ont été retenues pour l’analyse de régression linéaire multivariée.

Résultats

Les analyses de régression multivariées démontrent que le nombre de DAPCM par jour diminue pour les deux sites lorsque la durée moyenne de séjour des patients non hospitalisés à l’urgence diminue (HF:b=1,17, p<0,001; HD:b=1,41, p<0,001) et lorsqu’un médecin dédié aux patients ambulatoires est présent (HF:b=-4,35, p<0,001; HD:b=-5,48, p<0,001). De plus, des facteurs reliés à l’achalandage des salles d’urgence et la raison primaire de consultation ont également eu un effet sur le nombre de DAPCM par jour.

Conclusion

Des efforts devraient être faits afin de diminuer la durée moyenne de séjour des patients non hospitalisés à l’urgence et d’assurer la présence d’un médecin dédié aux patients ambulatoires pour diminuer le nombre de DAPCM.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Étude des facteurs hospitaliers associés aux départs avant prise en charge médicale à l’urgence d’un centre hospitalier de soins tertiaires
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Étude des facteurs hospitaliers associés aux départs avant prise en charge médicale à l’urgence d’un centre hospitalier de soins tertiaires
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Étude des facteurs hospitaliers associés aux départs avant prise en charge médicale à l’urgence d’un centre hospitalier de soins tertiaires
      Available formats
      ×

Copyright

Corresponding author

Correspondance: Dr. Nicolas Elazhary, Service universitaire de médecine d’urgence, Département de médecine de famille & de médecine d’urgence, Université de Sherbrooke3001, 12e avenue Nord, Z7-3026, Sherbrooke, QC J1H 5N4; Email: nicolas.elazhary@USherbrooke.ca

References

Hide All
1. Cheng, I, Lee, J, Mittmann, N, et al. Implementing wait-time reductions under ontario government benchmarks (pay-for-results): A cluster randomized trial of the effect of a physician-nurse supplementary triage assistance team (MDRNSTAT) on emergency department patient wait times. BMC Emerg Med 2013;13:17, doi: 10.1186/1471-227X-13-17.
2. Schull, M, Hatcher, CM, Guttmann, A, et al. Development of a consensus on evidence-based quality of care indicators for canadian emergency departments. ICES Investigative Report. Toronto: Institute for Clinical Evaluative Sciences; 2010.
3. Bindman, AB, Grumbach, K, Keane, D, et al. Consequences of queuing for care at a public hospital emergency department. JAMA 1991;266(8):1091-1096.
4. Rowe, BH, Channan, P, Bullard, M, et al. Characteristics of patients who leave emergency departments without being seen. Acad Emerg Med 2006;13(8):848-852.
5. Kennedy, M, MacBean, CE, Brand, C, et al. Review article: Leaving the emergency department without being seen. Emerg Med Australas 2008;20(4):306-313, doi: 10.1111/j.1742-6723.2008.01103.
6. 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):439-447, doi: 10.1111/j.1553-2712.2012.01327.x.
7. Crilly, J, Bost, N, Thalib, L, et al. Patients who present to the emergency department and leave without being seen: Prevalence, predictors and outcomes. Eur J Emerg Med 2013;20(4):248-255, doi: 10.1097/MEJ.0b013e328356fa0e.
8. Schull, M, Vermeulan, M, Guttmann, A, et al. Better performance on length-of-stay benchmarks associated with reduced risk following emergency department discharge: an observational cohort study. CJEM 2015:17(3): 253-262.
9. Carron, PN, Yersin, B, Trueb, L, et al. Missed opportunities: Evolution of patients leaving without being seen or against medical advice during a six-year period in a Swiss tertiary hospital emergency department. Biomed Res Int 2014;2014:690368, doi: 10.1155/2014/690368.
10. Lovett, PB, Kahn, JA, Greene, SE, et al. Early quick acuity score provides more complete data on emergency department walkouts. PLoS One 2014;9(1):e85776, doi: 10.1371/journal.pone.0085776.
11. Kurowski, EM, Byczkowski, T, Timm, N. Return visit characteristics among patients who leave without being seen from a pediatric ED. Am J Emerg Med 2012;30(7):1019-1024; doi: 10.1016/j.ajem.2011.06.017.
12. Tothy, AS, Staley, S, Dean, EK, et al. Pediatric left-without-being-seen patients: What happens to them after they leave the pediatric emergency department? Pediatr Emerg Care 2013;29(11):1194-1196, doi:10.1097/PEC.0b013e3182a9f7ab.
13. Gravel, J, Gouin, S, Carriere, B, et al. Unfavourable outcome for children leaving the emergency department without being seen by a physician. CJEM 2013;15(5):289-299.
14. Goldman, RD, Macpherson, A, Schuh, S, et al. Patients who leave the pediatric emergency department without being seen: A case-control study. CMAJ 2005;172(1):39-43.
15. Gabayan, GZ, Asch, SM, Hsia, RY, et al. Factors associated with short-term bounce-back admissions after emergency department discharge. Ann Emerg Med 2013;62(2):136-144.e1, doi: 10.1016/j.annemergmed.2013.01.017.
16. Crilly, J, Bost, N, Gleeson, H, et al. Patients who presented to an Australian emergency department and did not wait or left against medical advice: A prospective cohort follow-up study. Adv Emerg Nurs J 2012;34(4):357-368, doi: 10.1097/TME.0b013e3182705efb.
17. Ng, Y, Lewena, S. Leaving the paediatric emergency department without being seen: Understanding the patient and the risks. J Paediatr Child Health 2012;48(1):10-15, doi: 10.1111/j.1440-1754.2011.02187.x.
18. Jerrard, DA, Chasm, RM. Patients leaving against medical advice (AMA) from the emergency department—disease prevalence and willingness to return. J Emerg Med 2011;41(4):412-417, doi: 10.1016/j.jemermed.2009.10.022.
19. Carter, EJ, Pouch, SM, Larson, EL. The relationship between emergency department crowding and patient outcomes: A systematic review. J Nurs Scholarsh 2014;46(2):106-115, doi: 10.1111/jnu.12055.
20. Linden, MCvd, Lindeboom, R, Linden, Nvd, et al. Walkouts from the emergency department: Characteristics, reasons and medical care needs. Eur J Emerg Med 2014;21(5):354-359, doi: 10.1097/MEJ.0000000000000086.
21. Hobbs, D, Kunzman, SC, Tandberg, D, et al. Hospital factors associated with emergency center patients leaving without being seen. Am J Emerg Med 2000;18(7):767-772.
22. Derlet, R, Richards, J, Kravitz, R. Frequent overcrowding in U.S. emergency departments. Acad Emerg Med 2001;8(2):151-155.
23. Polevoi, SK, Quinn, JV, Kramer, NR. Factors associated with patients who leave without being seen. Acad Emerg Med 2005;12(3):232-236.
24. Kulstad, EB, Hart, KM, Waghchoure, S. Occupancy rates and emergency department work index scores correlate with leaving without being seen. West J Emerg Med 2010;11(4):324-328.
25. Baker, DW, Stevens, CD, Brook, RH. Patients who leave a public hospital emergency department without being seen by a physician. Causes and consequences. JAMA 1991;266(8):1085-1090.
26. Monzon, J, Friedman, SM, Clarke, C, et al. Patients who leave the emergency department without being seen by a physician: A control-matched study. CJEM 2005;7(2):107-113.
27. Mohsin, M, Forero, R, Ieraci, S, et al. A population follow-up study of patients who left an emergency department without being seen by a medical officer. Emerg Med J 2007;24(3):175-179.
28. Stang, AS, McCusker, J, Ciampi, A, et al. Emergency department conditions associated with the number of patients who leave a pediatric emergency department before physician assessment. Pediatr Emerg Care 2013;29(10):1082-1090, doi: 10.1097/PEC.0b013e3182a5cbc2.
29. Wilson, BJ, Zimmerman, D, Applebaum, KG, et al. Patients who leave before being seen in an urgent care setting. Eur J Emerg Med 2013;20(6):420-424, doi: 10.1097/MEJ.0b013e328359167e.
30. Pham, JC, Ho, GK, Hill, PM, et al. National study of patient, visit, and hospital characteristics associated with leaving an emergency department without being seen: Predicting LWBS. Acad Emerg Med 2009;16(10):949-955, doi: 10.1111/j.1553-2712.2009.00515.x.
31. Grosgurin, O, Cramer, B, Schaller, M, et al. Patients leaving the emergency department without being seen by a physician: A retrospective database analysis. Swiss Med Wkly 2013;143:w13889, doi: 10.4414/smw.2013.13889.
32. Fayyaz, J, Khursheed, M, Mir, MU, et al. Missing the boat: Odds for the patients who leave ED without being seen. BMC Emerg Med 2013;13:1, doi: 10.1186/1471-227X-13-1.
33. Bambi, S, Scarlini, D, Becattini, G, et al. Characteristics of patients who leave the ED triage area without being seen by a doctor: A descriptive study in an urban level II Italian university hospital. J Emerg Nurs 2011;37(4):334-340, doi: 10.1016/j.jen.2010.05.004.
34. Fernandes, CM, Price, A, Christenson, JM. Does reduced length of stay decrease the number of emergency department patients who leave without seeing a physician? J Emerg Med 1997;15(3):397-399.
35. Vanier, L. Communication orale. Entrevue téléphonique avec le Dr Laurent Vanier, médecin-conseil à la Direction nationale des urgences, 2 septembre 2014, Sherbrooke.
36. TVA nouvelles. Reportage diffusé le 11 août 2014. Quitter l'urgence sans voir le médecin. Available at: http://fr.canoe.ca/infos/videos/quitter-lurgence-sans-voir-le-medecin-explications-17h/3725808393001 (accessed September 20, 2014).
37. Gaucher, N, Bailey, B, Gravel, J. Who are the children leaving the emergency department without being seen by a physician? Acad Emerg Med 2011;18(2):152-157, doi: 10.1111/j.1553-2712.2010.00989.x.
38. Gaucher, N, Bailey, B, Gravel, J. For children leaving the emergency department before being seen by a physician, counseling from nurses decreases return visits. Int Emerg Nurs 2011;19(4):173-177, doi: 10.1016/j.ienj.2011.03.002.
39. Hsia, RY, Asch, SM, Weiss, RE, et al. Hospital determinants of emergency department left without being seen rates. Ann Emerg Med 2011;58(1):24-32.e3, doi: 10.1016/j.annemergmed.2011.01.009.
40. Ibanez, G, Guerin, L, Simon, N. Which improvements could prevent the departure of the left-without-being-seen patients? Emerg Med J 2011;28(11):945-947, doi: 10.1136/emj.2009.086397.
41. Registre des urgences. Banque de données en ligne. Available at: http://www.cmisstats.mtl.rtss.qc.ca/tabloclip/index.php?resource_s=com.utilisation_services.urgence.patciv.urgence (accessed September 20, 2014).
42. Kamali, MF, Jain, M, Jain, AR, et al. Emergency department waiting room: Many requests, many insured and many primary care physician referrals. Int J Emerg Med 2013;6(1):35, doi: 10.1186/1865-1380-6-35.
43. Sun, BC, Binstadt, ES, Pelletier, A, et al. Characteristics and temporal trends of left before being seen visits in US emergency departments, 1995-2002. J Emerg Med 2007;32(2):211-215.
44. La Direction des communications du Ministère de la Santé et des Services Sociaux. Gouvernement du Québec; 2006. Guide de gestion de l’urgence. Available at: http://publications.msss.gouv.qc.ca/acrobat/f/documentation/2006/06-905-01.pdf (accessed September 20, 2014).

Keywords

Type Description Title
WORD
English Version

Elazhary supplementary material S1
English version of the manuscripts

 Word (91 KB)
91 KB

Étude des facteurs hospitaliers associés aux départs avant prise en charge médicale à l’urgence d’un centre hospitalier de soins tertiaires

  • Nicolas Elazhary (a1) (a2), Marie-Laure Dolbec (a3), Thierry Boucher (a3), Jean-François Deshaies (a1), Alain Vanasse (a1) (a2) and René Beaudoin (a1)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.