Emergency department conditions associated with the number of patients who leave a pediatric emergency department before physician assessment.
OBJECTIVE
As emergency department (ED) waiting times and volumes increase, substantial numbers of patients leave without being seen (LWBS) by a physician. The objective of this study was to identify ED conditions reflecting patient input, throughput, and output associated with the number of patients who LWBS in a pediatric setting.


METHODS
This study was a retrospective, descriptive study using data from 1 urban, tertiary care pediatric ED. The study population consisted of all patient visits to the ED from April 2005 to March 2007. Multivariate Poisson regression analyses were used to examine the impact of the timing of patient arrival and ED conditions including patient acuity, volume, and waiting times on the number of patients who LWBS.


RESULTS
During the study period, there were 138,361 patient visits corresponding to 2190 consecutive shifts; 11,055 patients (8%) left without being seen by a physician.In the multivariate analysis, the throughput variables, time from triage to physician assessment (rate ratio, 2.11; 95% confidence interval, 2.01-2.21), and time from registration to triage (rate ratio, 1.55; 95% confidence interval, 1.25-1.90) had the largest association with the number of patients who LWBS.


CONCLUSIONS
In the study ED, throughput variables played a more important role than input or output variables on the number of patients who LWBS. This finding, which contrasts with a work done previously in an ED serving primarily adults, highlights the importance of pediatric specific research on the impacts of increasing ED waiting times and volumes.
From the *Department of Pediatrics, University of Calgary, Calgary, Alberta; and Departments of †Epidemiology and ‡Economics, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
Antonia Schirmer
AS
Stang
Jane
J
McCusker
Antonio
A
Ciampi
Erin
E
Strumpf
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003441:Crowding; D003953:Diagnosis-Related Groups; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D010352:Patient Dropouts / Q000523:psychology; D010355:Patient Identification Systems / Q000706:statistics & numerical data; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D013997:Time Factors; D014218:Triage