Emergency department patients who leave without seeing a physician: the Toronto Hospital experience.
OBJECTIVE
To determine why emergency department patients leave without being seen by a physician and whether they receive alternate medical care.


METHODS
A prospective, cross-sectional study of patients who left without being seen. Charts were reviewed for population demographics, presenting complaints, and clinical acuity rating. Follow-up was achieved within 6 weeks through mailed survey questionnaires and telephone interviews.


METHODS
Two inner-city EDs of the Toronto Hospital, a quaternary care facility.


METHODS
All 423 patients who registered for care and left without being seen during a 16-week period from January to May 1991.


RESULTS
Of 23,933 registered patients, 423 (1.4%) left without being seen. Follow-up was achieved on 39% of patients (165 of 423). Sixty-seven percent of those who left (284 of 423) had low acuity ratings. Of the 165 survey respondents, 107 (65%) left between 30 minutes and 2 hours after registration. The major reasons cited for leaving included prolonged waiting time (99 of 165, 60%), perceived difficulties with hospital staff (46 of 165, 28%), and pressing commitments elsewhere (45 of 165, 27%). Ninety-two percent (152 of 165) believed they should be evaluated by a physician within 1 hour of presentation. Forty-eight percent (80 of 165) sought further medical attention within 24 hours. Personal physicians (65 of 165, 39%) and other EDs (29 of 165, 18%) were the most common sources of further medical care.


CONCLUSIONS
The majority of survey respondents had a low acuity rating and left because of prolonged waiting times. Most of these patients sought alternate medical care through their personal physician or other EDs.
Department of Emergency Medicine, St Paul's Hospital, Vancouver, Canada.
C M
CM
Fernandes
M R
MR
Daya
S
S
Barry
N
N
Palmer
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009864:Ontario; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D017749:Total Quality Management; D014850:Waiting Lists