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


CONCLUSIONS
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.
*Department of Emergency Medicine,Dalhousie University,Saint John,NB.
Jacqueline
J
Fraser
†Horizon Health Network,Saint John Regional Hospital,Saint John,NB.
Paul
P
Atkinson
*Department of Emergency Medicine,Dalhousie University,Saint John,NB.
Audra
A
Gedmintas
*Department of Emergency Medicine,Dalhousie University,Saint John,NB.
Michael
M
Howlett
*Department of Emergency Medicine,Dalhousie University,Saint John,NB.
Rose
R
McCloskey
*Department of Emergency Medicine,Dalhousie University,Saint John,NB.
James
J
French
D000328:Adult; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D019538:Health Care Surveys; D006786:Hospitals, Urban; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D009523:Newfoundland and Labrador; D017063:Outcome Assessment, Health Care; D016079:Refusal to Treat / Q000706:statistics & numerical data*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D014218:Triage; D014850:Waiting Lists
left without being seen (LWBS); triage; wait times