title: Who leaves the emergency department without being seen? A public hospital experience in Georgetown, Guyana.
abstract: BACKGROUND
  Left without being seen (LWBS) proportions are commonly used as quality control indicators, but little data is available on LWBS proportions in the developing world. This study sought to determine the proportion and characteristics of patients who LWBS from the emergency department (ED) of the main public hospital in Georgetown, Guyana.
  
  
  METHODS
  This is a retrospective cross-sectional analysis of an ED quality assurance database. Registration personnel collected demographic information on patients presenting to the ED over a 2-week period in July 2010. Both univariate and multivariate analysis were conducted to determine patient characteristics associated with LWBS.
  
  
  RESULTS
  The LWBS proportion was 5.7%. In univariate analysis, patients 18 or older (OR 1.48, 95%CI 1.03-2.12), presenting during the 4PM-12AM shift (OR 2.15, 95%CI 1.53-3.01), with non-urgent triage classification (OR 1.88, 95%CI 1.76-4.66), with non-traumatic chief complaints (OR 1.70, 95%CI 1.14-2.55), or who were not transferred (OR 2.13, 95%CI 1.00-4.55) had significantly higher odds of LWBS. On multivariate analysis, only patients 18 or older (OR 1.54, 95%CI 1.02-2.33), presenting during the 4PM-12AM shift (OR 2.29, 95%CI 1.54-3.40), and with non-traumatic chief complaints (OR 2.39, 95%CI 1.43-4.02) were found to be significantly associated with LWBS. Sex, residence in the capital city, time to triage, transfer status, use of EMS, and triage classification were not statistically associated with LWBS.
  
  
  CONCLUSIONS
  LWBS proportions are used as quality control indicators and this study determined the LWBS proportion at a public hospital in a developing country and some of the patient characteristics associated with LWBS. This can be helpful to develop strategies to decrease LWBS proportions and to assess progress over time.
authors.affiliation: Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN 37232-4700, USA. Kendra.parekh@vanderbilt.edu
authors.forename: Kendra P
authors.initials: KP
authors.lastname: Parekh
authors.forename: Stephan
authors.initials: S
authors.lastname: Russ
authors.forename: David A
authors.initials: DA
authors.lastname: Amsalem
authors.forename: Navindranauth
authors.initials: N
authors.lastname: Rambaran
authors.forename: Seth W
authors.initials: SW
authors.lastname: Wright
mesh_terms: D000293:Adolescent; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006172:Guyana; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006779:Hospitals, Public; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D016312:Treatment Refusal / Q000706:statistics & numerical data*; D055815:Young Adult